Wiki MUEs surgical codes with multiple units

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tdrake

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Does anyone have any tips/tricks with determining by CPT code, which can be billed on one line with multiple units vs on separate lines with different modifiers? We've read through all of the MUE information multiple times, and asked Medicare on specific denials, and we can't seem to get a straight answer. We thought we had it figured out by MUE classification type, but that isn't working either lol. Spine codes and some hand codes seem to be okay on one line with multiple units however foot/ankle codes are not (metatarsals not phalanges), and all of these codes are MAI 3's and have MUE values that allow for the # of units we're billing for. I'm hoping someone has the magic answer lol. I appreciate it!
 
It depends, what codes are you specifically talking about? It is easier to help with more specifics. What are you trying to bill?
For example, if you are talking about a hammertoe (28285) that would be reported on separate lines with the T mods per toe. You also have to understand the MUE rationale reason.

My 1st question is always, "Was it coded correctly with the correct codes in the 1st place?"
Then start breaking it down if there are multiple lines.
Are the diagnosis pointers assigned correctly?
When you are talking foot and ankle (as with everything else) it is really important the codes are correct, the modifiers and the ICD-10s are exact. Like, if you had three toes but you assign all 3 ICD-10 to every line, that won't fly.

It's not just the MUEs and MAIs, you have to check the actual NCCI manual too. https://www.cms.gov/files/document/medicare-ncci-policy-manual-2024-chapter-4.pdf
H. Medically Unlikely Edits (MUEs)
2. Providers/suppliers should be cautious about reporting services on multiple lines of a claim using modifiers to bypass MUEs. The MUE values are set so that such occurrences should be uncommon. If a provider/supplier does this frequently for any HCPCS/CPT code, the provider/supplier may be coding units of service (UOS) incorrectly. The provider/supplier may consider contacting their national healthcare organization or the national medical/surgical society whose members commonly perform the procedure to clarify the correct reporting of UOS.

See here: V. Medically Unlikely Edits (MUEs)

Spine codes make sense with one line and multiple units for the add-ons because it is additional levels. (e.g. 22614).
 
Thank you Amy. We truly have read through everything, and there just doesn't seem to be a clear answer as to when to bill them on one line with multiple units vs on separate lines. For example, CPT code 26350, and 25270 paid on one line with multiple units, however 28232 denied when billed the same way. These codes are all billed per tendon so why would the first 2 be okay on one line, but not the 28232? I appreciate it!
 
26350 & 25270 are per "each".
28232 is toe single tendon, but your issue here is that it has separate procedure designation.
Look at the full CPT descriptions.

The issue with 28232 is probably separate procedure, not the units per line.
However, this is mixing hand/wrist vs. foot/toe.

I am just going by what you state here, but if you had a specific example it would be easier. It is going to depend on what was done during the case, if it was coded correctly, what the denial reason was, and what the rest of the claim (dx, mods, etc.) looks like.

Are you, or is the person coding new to orthopedics? It seems like maybe the reason for the denials is being confused. It may not be the MUE or units per line, it may be the coding itself from the start.
 
Also, meant to add. I can't think of many scenarios where I billed multiple units per line when coding ortho surgeries unless it was an add-on code. Spines for multi-level fusions would be one instance (e.g.; 22614x3). Even when doing hammertoes, I would do one line per toe one unit.
 
Thank you Amy. She's definitely not new to ortho, and the denial states Date range not valid with units submitted; missing/incomplete/invalid "from" dates of service, and this is what it usually says when it's related to this issue.
 
Is there an error on the date of service on the claim? Even a typo? There shouldn't be a date range for an elective type surgery. Or, even if the surgery was during a trauma or IP stay, the surgery itself would only be one DOS. Look at the actual dates on the claim or in the billing system.
 
no there are no errors with the DOS on any of the claims. This is an ongoing issue we've had for a few years, and again, I'm just trying to find a better way to determine which codes can go on one line with multiple units vs separate lines as now we just track them on a google sheet to figure it out as they pay or deny. I appreciate your help, but there doesn't seem to be an easier way lol. Thanks again.
 
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