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Denial for multiple units

  1. #1
    Default Denial for multiple units
    Exam Training Packages
    Please help!
    I work for a Gastroenterologist who recently performed a follow up colonoscopy on an est.
    pt with a 10 year history of ulcerative colitis. The physician removed a 3 mm polyp with cold biopsy forceps in the sigmoid colon. He also obtained biopsies every 10 cm due to the patients long history of ulcerative colitis. The charge was 88305 x 13 units and 88312 x1 unit. Medicare paid for the 88312 and denied 88305.
    I have tried to find the actual policy regarding maximum unit edits and have unable to find it. I want to make sure I use modifier 59 correctly. I would appreciate any help I can get.

  2. #2
    Medicare denied all 13 of the 88035? Did you use modifier 59 on any of these codes?

  3. #3
    Pensacola, Florida
    Check with your MAC. We are in Indiana, and the max units per line item is 5. We have been instructed to use modifier 76 on subsequent line items. I can't say that I have had 13 units, though. I don't know if there is a max number of units allowed total or not.
    Bridgette Martin LPN, CPC, CEMC, CGIC

  4. #4
    Yes the did deny all 13 units of 88305. I did not use modifier 59 at all.

  5. #5
    I have some documentation that I have obtained from the CMS website that discusses how to bill this. I'd be happy to help you if you want to contact me. I do billing for a pathology lab and we bill multiple units quite a bit. I can help you find the information about the numbers allowed and where the new manuals are located. Try this link first if it doesn't help let me know.
    from there go to Chapter 16. I also have a copy of the Correct Coding Edits information for this year as well that I'd be happy to send you a copy of the section you need.

  6. #6
    Thank you so much for the info!

  7. #7
    Medicare has not published MUE ( Medically Unlikely Edits) for 88305 yet. We bill out multiple units of 88305 too, I add modifier .59 in units more than 7.
    so if youbilled 13 units, I wiolu definately add .59 on the last 6 .

    Hope this helps!

  8. #8
    sorry for the typo............its Monday morning !!!

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