Wiki surgery (professional) coding, billing allowable units vs units in procedure

[melanied]

Hello,
I bill for a Neurosurgery office and we are seeing denials for units billed (example 22853 in a procedure)for Medicare. Medicare allows up to 4 units paid and we did a procedure with 5 levels, so we billed 5 units. The line item is denied for too many units. Do we will bill the claims with the allowable units of 4 and disregard the other unit or do we bill out the 5 units and then have to appeal the denied line item?
And do we do the same for commercial payers?

Thank you

 

[Orthocoderpgu]

This is a clinical edit. Meaning that you can appeal the denial of the MUE with medical records. If this were a policy edit, you would not be allowed more than the MUE even with medical records. Knowing the MUE, I would bill with four units on one line and the fifth on a separate line so that at least the four units can be paid initially and not have to wait for payment. Private payers may or may not follow the MUE.