Wiki Multiple units same MOH's site?

[sinman0531]

I have a situation I have never encountered before. One of my doctors performed a MOH's procedure, and the first stage defect is 5cmx6.5cm. The stage was separated into 32 blocks. If I bill a 17313 and 17315, that will only cover a maximum of 20 blocks.

Can I bill multiple lines of 17313 to account for the extra blocks? I feel like I can't, but the MUE is also 3, so....Should I attach a -22 instead? and would I attach it to the 17313 or the 17315?

 

[iowagirl77]

You state the MUE of 17313 is 3, but you'd only bill 1 unit of 17313. Since this is all the same site it would be 17313 x1, 17315 x27. What is the MUE for 17315?

 

[thomas7331]

You shouldn’t change the way you code based on MUE edits - you still need to accurately report what was documented. In this case you report 17315 with 27 units, and you can appeal the MUE denial with records showing that the units billed are correct. Some contractors may allow you to split the units onto multiple lines, i.e. bill 15 units on one line and the remaining 12 units onto another, with a 59 modifier. However, I think for most payers this will still create an MUE denial these days.

Adding units to 17313 would be incorrect coding for this situation, as would the use of modifier 22.