Cardiology Coding Alert

Question: If you have more units than MUEs allow, what is the appropriate reporting method? Iowa Subscriber Answer: CMS states that MUEs (medically unlikely edits) reflect the maximum number of units the vast majority of properly reported claims for a particular code would have, so you shouldn't need to override them often. But you can override an MUE when the cardiologist performs and documents a medically necessary number of services that exceed the limit. Check your payer's reporting preference. HCPCS offers modifier GD (Units of service exceeds medically unlikely edit value and represents reasonable and necessary services). But there is little information available on proper use of this modifier. A CMS FAQ states that "since each line of a claim is adjudicated separately against the MUE value for the code on that line, the appropriate use of Current Procedural Terminology (CPT) modifiers to report the same code on separate lines [...]