General Surgery Coding Alert

If you've heard rumors of a new category of coding edits, you can take a deep breath and relax. Medicare has halted, at least temporarily, its plans to develop so-called "medically unbelievable" edits (MUEs) for inclusion in the National Correct Coding Initiative (NCCI).

The Centers for Medicare and Medicaid Services announced in Transmittal 105 (Feb. 18, 2005) that it had hired AdminaStar Federal to develop MUEs to target multiple claims for particular services made for one patient on the same day.

Carriers have had frequency edits in place for years, says consultant Quinten Buechner, MS, MDiv, CPC, president of ProActive Consultants in Cumberland, Wis. The MUEs, then, although adding complexity to the NCCI, may have helped to standardize practices among all payers.

At this point, however, general surgery practices needn't worry about a new category of NCCI edits. Only a few weeks after its initial announcement, CMS rescinded without explanation its plans to establish the MUEs.

A source within CMS confirmed, however, that the agency expects to reissue the MUEs, with modifications, at a later (undisclosed) date. Keep reading General Surgery Coding Alert for more information as soon as it becomes available.