DecisionHealth, DecisionHealth - 2016 Issue 4 (April)

Medically unlikely edits Q & A

Question: What is the difference between a CCI edit and a medically unlikely edit (MUE)?
 
Question: I understand that medically unlikely edits (MUEs) limit the number of services you can perform on a patient on the same day, but what do the medically unlikely edit adjudication indicators mean?
Question: Medicare is denying 64640 (Destruction by neurolytic agent; other peripheral nerve or branch) when we report the service bilaterally at three levels. We've tried coding the service on three lines with 64640-50; 64640-50, 59; 64640-50, 59 and on a single line with 64640-50 x 3. Both times the claim was denied with remittance advice code M53 Missing/incomplete/invalid days or units of service. Can you explain why we’re getting this denial?

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