Health Information Management

Two years later, MUEs remain a puzzle

APCs Insider, October 2, 2009

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A patient arrives at the hospital with a major head injury. The physician orders an MRI to evaluate a subdural hematoma. Soon, the hospital submits the claim, reporting four units of CPT code 70553 for an MRI of the brain with and without contrast material.
 
Before long, the claim comes back to the hospital “return to provider” (RTP). Why? Code 70553 is on CMS’ list of medically unlikely edits (MUE). Medicare allows its contractors to pay hospitals for only one MRI per patient on a single date of service. After determining that the radiology department provided only one MRI, the hospital resubmits the bill with code 70553 at one unit. Medicare pays the claim.
 
Continue reading “Two years later, MUEs are still a puzzle” on HCPro’s Web site. Briefings on APCs subscribers have free access to this article in the October issue.



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