tci General Surgery Coding Alert - 2008 Issue 4

CMS Expands Medically Unlikely Edits for the New Year

A new modifier may be required for -unlikely- procedures The controversial medically unlikely edits (MUEs) that CMS instituted in 2007 are set to expand into new areas starting in January -- and your claims could wind up on the chopping block as a result. The lowdown: Until now, the MUEs have focused on anatomically unlikely scenarios. For example, if you try to bill for a hysterectomy on a male patient or amputation of three arms, these edits will kick in and prevent it. But starting in January, MUEs will additionally focus on "clinical judgment" issues. As before, the MUEs...

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