• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

Wiki surgery (professional) coding, billing allowable units vs units in procedure

Create Wiki Sort by votes
M

melanied

Contributor
Messages
20
Best answers
0
Hello,
I bill for a Neurosurgery office and we are seeing denials for units billed (example 22853 in a procedure)for Medicare. Medicare allows up to 4 units paid and we did a procedure with 5 levels, so we billed 5 units. The line item is denied for too many units. Do we will bill the claims with the allowable units of 4 and disregard the other unit or do we bill out the 5 units and then have to appeal the denied line item?
And do we do the same for commercial payers?

Thank you
 
1
This is a clinical edit. Meaning that you can appeal the denial of the MUE with medical records. If this were a policy edit, you would not be allowed more than the MUE even with medical records. Knowing the MUE, I would bill with four units on one line and the fifth on a separate line so that at least the four units can be paid initially and not have to wait for payment. Private payers may or may not follow the MUE.
 
Last edited:
You must log in or register to reply here.
Top