Wiki Mues for cpt code 26145

[cynsteve04@aol.com]

Hi
If the Mue has 6 and the next Colum has Mue rationale as 3. Does that mean i can only code 3 for a single date of service for Cpt code 26145? The Dr performed synovectomy on 4 different fingers

MUE Adjudication Indicator	MUE Rationale	Effective Date
6	3 Date of Service Edit: Clinical

Thankyou

 

[sls314]

Hi
If the Mue has 6 and the next Colum has Mue rationale as 3. Does that mean i can only code 3 for a single date of service for Cpt code 26145? The Dr performed synovectomy on 4 different fingers

MUE Adjudication Indicator	MUE Rationale	Effective Date
6	3 Date of Service Edit: Clinical

Thankyou

26145 has MUE of 6.

BTW - the column headers on what you posted are off by one. Are you using the CMS spreadsheet, or something created in your workplace where perhaps someone accidentally deleted a column header?

This is what your column headers should look like for that code

HCPCS/ CPT Code	Practitioner Services MUE Values	MUE Adjudication Indicator	MUE Rationale
26145	6	3 Date of Service Edit: Clinical	Clinical: Data

You can pull a new copy of the spreadsheet here if need be: https://www.cms.gov/medicare-medica...dicare/medicare-ncci-medically-unlikely-edits

 

[cgaston]

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/How-To-Use-NCCITools.pdf

I have attached a link to the Medicare guide explaining how to use the MUE table.

It shows that column D is the underlying category of rationale for each MUE (in this case, the rationale for this code is under category MAI 3).:

 

[thomas7331]

Hi
If the Mue has 6 and the next Colum has Mue rationale as 3. Does that mean i can only code 3 for a single date of service for Cpt code 26145? The Dr performed synovectomy on 4 different fingers

MUE Adjudication Indicator	MUE Rationale	Effective Date
6	3 Date of Service Edit: Clinical

Thankyou

Agree with the above posts - the MUE is 6 for this code.

Just a reminder, though - MUEs are a payment policy, not a coding guideline. You would code according to documentation, not to the MUE. MUE means 'medically unlikely', it doesn't mean it's impossible to exceed the units in the edit - the edits were created to catch potential errors, but in some cases providers will in fact exceed the units. If the provider's number of units exceeds the MUE value and the MUE rationale is clinical data, as in this case, you can appeal with notes and the denial will usually be reversed.