MUE's

[Jrl2789]

Hi, I have a provider who removed 14 separate lesions and made 14 separate incisions. CPT 24071 has a MUE of 2. He did 24071 on the left side for 3 separate areas and 24071 on the right side for 3 separate areas. The carrier paid all 3 for the right side but denied 1 unit on the left side and paid the other 2. Do MUE's count per site or side or does the MUE of 2 count per patient per day? Thank you so much

 

[sls314]

Hi, I have a provider who removed 14 separate lesions and made 14 separate incisions. CPT 24071 has a MUE of 2. He did 24071 on the left side for 3 separate areas and 24071 on the right side for 3 separate areas. The carrier paid all 3 for the right side but denied 1 unit on the left side and paid the other 2. Do MUE's count per site or side or does the MUE of 2 count per patient per day? Thank you so much

The first step is to verify that the correct CPT code was billed. CPT 24071 refers to the excision of a subcutaneous soft tissue tumor from the upper arm, measuring 3 cm or greater.


Did the provider truly excise 14 subcutaneous tumors 3 cm or greater from the patient’s upper arms? The "MU" in MUE stands for "medically unlikely" and without being able to read the visit note, my first instinct is that this scenario definitely sounds medically unlikely!

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If you've confirmed that 20471 is the correct CPT code and the provider did excise 14 subcutaneous lesions of that size from the patient's upper arms, the next thing you can do is review the MUE for that CPT code.

24071 has an MUE indicator: "3 Date of Service Edit: Clinical"

These are “per day” edits based on clinical benchmarks. They may pay for services that exceed the MUE value if you appeal a claim denial and provide adequate documentation to support the medical necessity of correctly reported units.

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You can read about MUEs and MUE indicators in more detail here:

https://www.cms.gov/files/document/revised-modification-medically-unlikely-edit-mue-program-mm8853.pdf

 

[Jrl2789]

Yes, the provider did truly excise 14 subcutaneous tumors. Only 6 of the 14 was cpt 24071. Carrier has paid 5 of the 6 and denied 1 unit for MUE. Thank you!