DecisionHealth, DecisionHealth - 2019 Issue 12 (December)

If multiple biopsies exceed MUEs, expect a denial — unless you can split them by side

Question: My doctor recently did 10 biopsies on a single patient and we’re billing 11102 (Tangential biopsy of skin; single lesion) and 11103 (Tangential biopsy of skin; each separate/additional lesion). I see by CMS’ medically unlikely edits (MUEs) update that the former has a practitioner services MUE value of 1, and the latter has a value of 6, so we’re clearly going to exceed that. I fear we’ll get caught in an edit. Is there anything we can do ahead of time to avoid a denial?

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