Wiki MUE Exceeded by 3 for 26145 what documentation is required

[konichiwa]

Hello,

Reimbursement issue regarding 26145 and exceeding the MEU of 6 by 3 units.

Scenario:

Provider bills 26145 x 9, exceeding the MUEs by 3 and states in the Op report that a "copious amount of hypertrophic tenosynovium was noted on the nine flexor tendons in the palm and a careful and sharp tenosynovectmoy of the nine tendons in the palm was then performed," would this statement satisfy MAI 3 requirement?

If so, why?

if not, why not?

if I could get a link to support either decision, this would be extremely helpful.

Thank you!

 

[Orthocoderpgu]

In my opinion this documentation supports your MUE

Keep in mind that insurance companies think that it's not possible to go over the MUE so to them the MUE is set in stone, which of course is inaccurate. Code 20610 has an MUE of 4 but it's possible to do 6, but very unlikely that all 6 would be done.

Even the CMS web site states that the procedures past MUE can be paid on appeal with records.

Be ready to appeal this.