Pathology/Lab Coding Alert
MUEs Take Aim at Test Units -- Learn Targeted Codes
Latest -black box- edits limit Pap, bone marrow and more CMS won't publish the list of Medically Unlikely Edits (MUEs) -- but don't let that stop you. We-ll tell you about the latest limits that impact your lab effective April 1. Look for These Edits In addition to edits mentioned in -More Edits Not Unlikely -- Don't Miss New MUEs- for gammaglobulin (82784 and 82787), bone marrow (85097) and all Pap codes, phase II includes other lab codes you need to know. Fetal lung maturity -- MUE limit of four units for multiple fetuses: Total cell counts -- MUE limit of one Blood typing -- MUE limit of four for electronic crossmatch Other lab codes
Because the MUE contractor and CMS released the edit list to professional societies for comment, you can find an -unofficial- version on the Internet. For the current list along with comments and rationale from the College of American Pathologists (CAP) and the American Society for Clinical Pathology (ASCP), go to www.cap.org/apps/docs/statline/pdf/mue_phaseII.pdf.
-Remember that you should appeal any medically necessary claims denied for these limits to ensure proper payment and provide feedback to the MUE program,- says Pamela Younes, MHS, HTL (ASCP), CPC, PA (ASCP), assistant professor at Baylor College of Medicine in Houston.
Gastrin:
- 82938 -- Gastrin after secretin stimulation -- MUE limit of six
- 82941 -- Gastrin -- MUE limit of one for carriers and three for fiscal intermediaries.
- 83661 -- Fetal lung maturity assessment; lecithin sphingomyelin (L/S) ratio
- 83662 -- Fetal lung maturity assessment; foam stability test
- 83663 -- Fetal lung maturity assessment; fluorescence polarization
- 83664 -- Fetal lung maturity assessment; lamellar body density.
- 86355 -- B cells, total count
- 86357 -- Natural killer (NK) cells, total count
- 86359 -- T cells; total count
- 86367 -- Stem cells (i.e., CD34), total count.
- 86900 -- Blood typing; ABO
- 86901 -- Blood typing; Rh (D).
- 87900 -- Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics -- MUE limit of two
- 86353 -- Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis -- MUE limit of seven.
Pathology/Lab Coding Alert
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