Wiki 83925 more than 1 unit

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Jcelin

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how can we bill 83925 for more than one unit on the same day for one patient? any suggestion please
 
83925 has a MUE of 4 so you should be able to bill up to 4 units per day, depending on how many units you are performing of course.
 
thank you so much for the reply... but the payer only paid 1 unit and the rest they denied it and said its a duplicate claim.... any suggestion.... i appreciate any help.... i want to get paid by 4 units per day.
 
You can and should appeal with copies of your lab results showing multiple opiates performed. Most of the commercial carriers will make additional payment. Depending on the carrier they will have internal medical policies for how many units they will reimburse for on a given day, however since there is a MUE in place that can and should be used in the language of your appeals and as additional supporting documentation for why more than 1 unit can be billed and should be paid on the same date of service.
 
My previous response is contingent on my assumption that the methodology for the opiate testing being performed supports the billing of more than 1 unit per day and any results will support that.
 
We are able to bill 4 units to Medicare Part A and Tricare will pay for up to 6 units (additional units require medical necessity). I'm unsure about the other payers.
 
We are able to bill 4 units to Medicare Part A

Are the services being performed in a facility/INPT? Or office/OTPT setting? What's your POS for the UDS?

As for any other carriers, each one could/does have their own medical policy in place for these services and based on those policies will determine what/how they process and pay. Up to the end of 2013 Aetna for instance would pay the first 2 units and then deny the remaining units unless an appeal was done with lab results to support the multiple units and then they would pay up to 2 more per day. Same with UHC. I would check with each carrier on their UDS policy.
 
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