Health Information Management

Medically unlikely edits remain a puzzle to providers

APCs Insider, May 30, 2008

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Earlier this year, CMS advised that the medically unlikely edit (MUE) value for units with CPT infusion codes 90766 or 90761, billed to FIs, would be increased on April 1, retroactive to the original date of January 1. However, not until the end of April did providers begin to notice infusion and injection claims being accepted for values that had previously been rejected, whereas reports of other MUEs appeared in the April CMS Hospital Open Door Forum.

Until the changes, CPT codes 90766 and 90761 with units of service greater than an unknown but variable quantity resulted in MUE denials, even when the services were clinically appropriate. The variable number of units causing denials increased provider frustration.

Click here to learn more about MUEs. Briefings on APCs subscribers have free access to this article in the April issue via their online subscriptions.

 



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