Wiki 17312 MUE edits

[mbellar]

Moh's Procedure had 8 stages, billed as follows
17311
17312 x7 units

Payer denied due to frequency- MUE is 4 units only
Filed appeal which was upheld, documentation supports the addt'l units

Any advise on this would be helpful

 

[sinman0531]

17312 has an MUE of 4 units. Any units after 4, you would want to use 17315. So it would look like

17311
17312 x4
17315 x3

 

[mbellar]

17312 has an MUE of 4 units. Any units after 4, you would want to use 17315. So it would look like

17311
17312 x4
17315 x3

I thought 17315 is for additional blocks not stages?

 

[thomas7331]

I thought 17315 is for additional blocks not stages?

You are correct. The post above is wrong - using 17315 for this purpose would be incorrect coding and would also cause your provider to be significantly underpaid as 17315 is a much lower value code that 17312.

Nowadays, MUE edits generally have to be appealed with notes in cases where you exceed the maximum. It used to be you could bypass the edits by splitting the lines, but I believe most of the Medicare contractors have closed that loophole now. In my experience, if your documentation is clear, then it should be a quick and simple process to get the denial overturned.