Radiology Coding Alert
Expect MUEs to Catch Claims for Unlikely Units Jan. 1
News flash: Beginning in January 2007, you'll have to contend with a new set of coding "edits" -- separate from the already-established National Correct Coding Initiative (NCCI) edits -- from CMS. But if the edits function as intended, you'll find them more a help than a hindrance.
Prevent Overpayment From Gross Mistakes
The new "Medically Unlikely Edits" (MUEs) are a refined version of the "Medically Unbelievable Edits" that CMS initially proposed -- and then, due to provider concerns, withdrew -- in 2005.
The goal of the new edits is to prevent overpayments caused by gross billing errors, usually due to clerical or billing system mistakes, said Niles R. Rosen, MD, medical director for Correct Coding Solutions LLC, which has worked hand-in-hand with CMS to develop the current edits, during a presentation at the AMA CPT and RBRVS 2007 Annual Symposium.
Rosen cited an example of a single CT scan that was billed (and inappropriately paid) as 10,001 units of service, as well as a shoulder arthroscopy billed as 141 units of service. "The number 141 was actually the minutes of anesthesia," he said.
"The MUEs will limit automatically the number of units of service you can bill for a service in any 24-hour period," Rosen said. The maximum units of service for a given CPT code have not been assigned arbitrarily, but by using common-sense criteria.
Edits Operate per Line, Not per Claim
If you due run afoul of the edits, you won't face denial for your entire claim, but only the single line item that violates the MUE guidelines, Rosen said. You will be able to appeal MUE edit rejections in the rare event you feel your claim was appropriately billed and meets the requirements of medical necessity.
Like the NCCI, the MUE will be updated quarterly and be subject to continuing refinement. "CMS and Correct Coding Solutions welcome suggestions and comments from providers," Rosen said.
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