tci Medicare Compliance & Reimbursement - 2014 Issue 16

Compliance: New Screening Edits Aim to Catch MUE Dodges

 Bilateral procedures are in CMS’ crosshairs. The Centers for Medicare & Medicaid Services (CMS) is keeping an eye out for coders’ attempts to bypass the medically unlikely edits (MUEs) for bilateral procedures by using the RT and LT modifiers (or separate line items with no modifiers at all) to avoid edits on modifier 50. CMS will institute new screening edits to ensure that claims are denied when bilateral billing isn’t allowed on a particular code. Background: If you report a bilateral procedure when the term “bilateral” is not included in the code’s CPT® descriptor, both...

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