tci General Surgery Coding Alert - 2023 Issue Q2

Reader Questions: Master This MUE ‘Override’ Guidance

Question: Our surgeon performed an open procedure and excised two distinct stomach biopsies, one from the fundus and one from the antrum. There is an MUE of 1 for this procedure. Is there any way with appropriate documentation to override the edit and bill for two biopsies? Louisiana Subscriber Answer: You cannot override the medically unlikely edit (MUE) of 1 for the procedure code 43605 (Biopsy of stomach, by laparotomy). To understand why, you need to look deeper into the MUE table (www.cms.gov/medicare-medicaid-coordination/national-correct-coding-initiative-ncci/ ncci-medicare/medicare-ncci-medically-unlikely-edits). The Centers for Medicare & Medicaid Services (CMS) states that MUEs reflect the...

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