Payer Frequency Edits-UHC

deansmommy4

Contributor
Local Chapter Officer
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Location
Manhasset, New York
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Hoping someone can help me.

I have been recently getting "Edits" (before claims reach payer) to detect any errors in billing/coding and payer edits referring to 26055 & 20550 from UHC/Oxford.
Apparently only (1) unit per day is allowed as of 10/1/2016.

This seems sort of silly as 20550 is a trigger finger injection done in the office, and 26055 is a tendon sheath incision done in the OR.
What happens when a patient has more than 1 trigger finger?
Does the MD truly have to schedule separate OR days, and separate office visits for each incision/injection?

How do we direct our MD's?

Any advice or education is appreciated.

Thanks.
 

iowagirl77

Guru
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Location
Cedar Rapids, IA
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Are you separating each one out or billing one line with multiple units? You might be able to get past edits if you put one unit per line and give them distinctive modifiers. I wasn't able to find something specific to Oxford UHC, but I found a UHC Community plan policy that states:

"Q: Would the MFD (maximum frequency per day) value for hand or foot bilateral procedures remain at 1 unit if it is possible to perform the procedure on multiple digits such as fingers or toes?
A: The MFD value would remain at 1 unit, however, HCPCS modifiers FA or F1-9 may be used to report specific fingers; TA or T1-9 may be used to report specific toes."

I hope that helps!

Susan Reinier
CPC-A
 
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