Health Information Management

Tip: Appropriately report units in excess of MUE

APCs Weekly Monitor, October 16, 2009

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In FAQ 8736, CMS instructs hospitals how to report units in excess of the medically unlikely edits (MUE) limits. Hospitals should place the same code on separate claim lines, with an appropriate modifier, so the number of units on each line is within the MUE limit.
 
Hospitals can use the following modifiers, according to the FAQ:
  • -76 (repeat procedure by same physician)
  •  -77 (repeat procedure by another physician)
  • Anatomic modifiers (e.g., -RT, -LT, -F1, -F2)
  •  -91 (repeat clinical diagnostic laboratory test)
  • -59 (distinct procedural service) only if no other modifier describes the service
In prior guidance (FAQ 8735), CMS said that contractors should apply MUE limits against each line of a claim, rather than the entire claim. Therefore, if a hospital reports a HCPCS or CPT code on more than one line of a claim by using modifiers, the contractors should separately adjudicate each line with that code against the MUE, according to CMS.
 
This tip was adapted from the article “Two years later, MUEs are still a puzzle” in the October issue of Briefings on APCs.



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