Pathology/Lab Coding Alert

Unit restrictions won't jeopardize rightful pay

CMS will not implement the “Medically Unbelievable Edits” (MUEs) that would have restricted the units of service you could report beginning July 1.

Based on concerns from lab groups such as the College of American Pathologists, American Society for Clinical Pathology, and American Clinical Laboratory Association, CMS agreed at the March 6 meeting of the Practicing Physicians Advisory Council to halt MUE implementation.

For about 1,000 laboratory and pathology CPT/ HCPCS Codes , the MUEs would have limited the number of times you could bill a particular code for the same patient on the same day, and you would not be able to use a modifier to override the edit.

Edit examples for commonly used codes that lab groups consider problematic include the following:

• 88305 (Level IV--Surgical pathology, gross and microscopic examination)--MUE limit proposal: two procedures. 

• 88342 (Immunohistochemistry [including tissue immunoperoxidase], each antibody)--MUE limit proposal: four procedures.

CMS may resubmit the MUE proposal through the normal rulemaking process.