[Aaj-ke-naam] Medically Unbelievable Edits in Effect July 1

[Provistas / Medical Coding .Net]

MEDICAL CODING .NET NEWS
February 2005, Volume 2

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DR. CARTER'S CORNER
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Darren Carter, MD, founder and President of Provistas, has a personal commitment to alleviating uncertainties in the new health compliance environment. He has authored dozens of articles, presents to professional and hospital associations, and serves on several editorial boards.

This column focuses on a couple of coding and compliance updates from CMS that go into effect in July.

Medically Unbelievable Edits
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CMS has instructed the Correct Coding Initiative (CCI) Contractor to create Medically Unbelievable Edits (MUEs), which will be released along with the quarterly CCI edit updates. MUEs are daily units of service limits associated with HCPCS codes. Billed services whose units surpass the MUE will be auto-denied. For the Outpatient Code Editor, implementation will first be line-item rejections. After six months, though, the edit will result in a denial. The effective date for these edits is July 1.

CMS stresses that the MUEs are only a supplement to local contractor units of service policies and encourages contractors to create more restrictive policies based on local practice patterns.

For more info, visit http://www.cms.hhs.gov/manuals/pm_trans/R105PI.pdf

Mammography Screening Diagnostic Coding Update
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Effective July 1, 2005, providers performing covered screening mammographies can use code V76.11 Special screening for malignant neoplasms, screening mammogram for high-risk patients to be reimbursed. This code is being added to V76.12 Special screening for malignant neoplasm, other screening mammography, which had been in effect since January, 1998.

For more info, visit http://www.cms.hhs.gov/manuals/pm_trans/R426CP.pdf

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