How to Medical Bill Multiple Units of a General Surgery Procedure?

By Michelle Stahl, Owner, Physicians Billing Service

You can Find Michelle Stahl, Owner of Physicians Billing Service on Google+.

Physicians and Medical Practices often ask our team of medical billing professionals, how to bill multiple units for a General Surgery procedure and the use of MUEs (Medically Unlikely Edits).  MUEs are an advanced and complex area of medical billing and collections, and my aim is to assist you in understanding their use.

In mid-June, the AAPC (American Academy of Professional Coders), published an insightful article that I wanted to share with you on ‘Unit Edits:  Learn These 4 Tips to Overcome General Surgery’.

Use of Medical Billing Modifiers

In summary, by the use of modifiers, one can get paid for several units during the same operative session.  The article offers valuable advice including:

Tip #1:  “Grasp the MUE Program”

  • MUE’s, ‘medically unlikely edits’, “limit the frequency a CPT code can be used for one patient on one date”, notes the article.
  • MUE’s differ from CCI (correct coding initiative) edits.  CCI’s “relate to code pairings (whether two codes can be billed together”.
  • Helpfully, the article notes that the “CMS publishes a quarterly list of MUEs that “includes specific CPT® or HCPCS codes, followed by the number of units that CMS will pay,” Harrington says. You can find the current list at www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/MUE.html.”

Tip #2:  “Know the Edits that Impact Your General Surgery”

  • Given that the CMS (Center for Medicare and Medicaid Services) MUE list contains thousands of CPT (Current Procedural Terminology) codes, Physicians Billing Service would be glad to assist you to understand which codes are most relevant to you.  The article notes “common general surgery codes and their MUE limit (in parentheses) are as follows:
    • 11646 —Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm (3)
    • 13100-13152 — Repair, complex … (1)
    • 19101 — Biopsy of breast; open, incisional (3)
    • 19301 —Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy) (1)
    • 24071 — Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; 3 cm or greater(3)
    • 36556— Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older (2)
    • 38510 — Biopsy or excision of lymph node(s); open, deep cervical node(s)(1)
    • 43611 — Excision, local; malignant tumor of stomach(1)
    • 44140 — Colectomy, partial; with anastomosis(2)
    • 46945 — Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group(1)”

Tip #3:  “Learn the Override Possibilities”

  • In the case that the patient’s medical records notes the rationale for a necessary procedure, the AAPC article notes that “even if it’s subject to an MUE, you can override the edits.”
  • As an example, “if your surgeon excises four distinct soft tissue tumors from different sites of the upper arm, you can report four units of 24071 using an appropriate modifier even though the code has an MUE limit of three.”

Tip #4:  “Focus on Appeal Options”

  • In the event that your Medical Practice’s claim is denied, your medical billers should pursue an appeal.

To conclude, the use of MUEs is complex and intimidating to many Physicians and Medical Practices.  Physicians Billing Service has proudly earned an A+ reputation for outsourced medical billing and collections.  Our expert team of professional medical billers would be glad to assist you in navigating this complexity and maximizing your practice’s cash flow and profitability.  Physicians Billing Service only gets paid when are clients get paid,and we would be glad to discuss our 100% satisfaction guarantee.  We can be reached via 240.382.Bill (2455) or via our web site www.medicalbillingandcollection.com.

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