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25075 21931

Betty Posted Wed 25th of April, 2012 15:56:55 PM

I need some help on coding these tumors out. We did '21931' 6 units, '25075' with 8 units '24075' with 6 units, '24071' 1 unit and '25071' 1 unit all for medicare. We received denials stating too many units and they can't tell us how many units they will allow. I am at a loss as to how to bill this out. Any help would be apprecited.

SuperCoder Answered Wed 25th of April, 2012 19:09:03 PM

If the submitted procedure code is denied because the quantity billed exceeds the CMS MUE guidelines,
(CMS-1500 professional services claim form) the service may be resubmitted with the correct units or
documentation that proved medical necessity of the quantity that was billed.
Please refer to this very important article.
http://dss.sd.gov/sdmedx/includes/portal/NCCI/MEDICALLY%20UNLIKELY%20EDIT%20BULLETIN.pdf

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