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88367 x6 too many services

charles Aiesi Posted Mon 24th of March, 2014 08:14:53 AM

we have a test that uses 6 FISH probes so we try to bill Medicare
88367x6 they deny saying too many rule but they say magic number is 4. First Coast Service Options.

can we bill 88367 x4 which is the magic number
and 88367 x2 with a 76 modifier

SuperCoder Answered Wed 26th of March, 2014 10:17:29 AM

This isn’t a published MUE (medically unlikely edit) from CMS, so it must be an unpublished limit, and possibly a local rule. That means there is no general instruction, and you’ll have to follow payer instruction. Typically, though, you would use modifier 59, not 76, to override a unit edit IF you have medical necessity for distinct, separate services that warrant separate reporting. Again, the final direction must come from your payer.

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