Wiki Biopsy

[andersont]

I have a provider who did 13 biopsies with an office call. How would this be billed? I tried 99214-25, 11100, 11101 x 12. Exceeds the limit. Thanks

 

[CatchTheWind]

You are right; the Medically Unlikely Edit limit for 11101 is 6. When your provider did more than the MUE, you have to submit the claim, get the denial, and then appeal it. It generally will be paid upon appeal.

By the way, why are you billing a 99214-25? Did the provider evaluate some other problem or do some work over and above what is normally included in the biopsies?

 

[andersont]

Yes, the patient had other issues along with the biopsies. When you say appeal, you talking about a redetermination or phone reopening? Thanks

 

[CatchTheWind]

Redetermination.