Coding for a surgical practice, they do debridements 11042 - 11047 and the MEU'S for the primary code is one. The add on codes we have found Medicare will pay up to 3. When we have more than 3 Medicare will deny for excessive units. How do you get them to pay? We have tried the first line appeal and still they do not pay. Is the some special information required to get them to pay units of 15 or more. Also when do debridements on both legs at the same time, do you add the same depths for both legs. We tried left and right and they were denied. Will modifier 50 work?
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Wiki Medicare MEU on debridements
- Thread starter NHORN
- Start date
OCD_coder
True Blue
You are correct 11045, 11046 and 11047 have no MUE units assigned.
One of the practices I audit for discovered that you can bill in groups of 4 per line, with modifier 59 on sequential lines and have no problem with payment.
MUE Edits from CMS:
11042 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction
11043 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction
11044 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction
The integumentary system is one organ system so you would categorize the debridements by type (depth) and add the sum total from all wounds. This code set is not a bilaterally applied code, so the modifier 50 is not appropriate.
One of the practices I audit for discovered that you can bill in groups of 4 per line, with modifier 59 on sequential lines and have no problem with payment.
MUE Edits from CMS:
11042 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction
11043 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction
11044 1 2 Date of Service Edit: Policy Code Descriptor / CPT Instruction
The integumentary system is one organ system so you would categorize the debridements by type (depth) and add the sum total from all wounds. This code set is not a bilaterally applied code, so the modifier 50 is not appropriate.
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