Wiki Patient with 3 kidneys

[darlene.dean@scionhealth]

Patient is status post renal transplant and has 3 kidneys, which is documented in the op notes for cystoscopy. The claim was submitted for 52005 (3 units) and 74420,26 (3 units). Medicare denied the claim stating "number of days or units of service exeeds our acceptable maximum." Any suggestions on how to get this paid?

 

[OCD_coder]

You will need to look up the Medically Unlikely Edits, for these two CPT codes the limit is 2.