tci General Surgery Coding Alert - 2013 Issue 10

Reader Question: Look Out for MUE Breast Limit

Question: Our surgeon excised four distinct breast biopsies from uniquely identified locations requiring separate incisions. We reported 19101 x 4 and got a denial. Did we do something wrong?Kansas Subscriber Answer: It sounds like you have adequate documentation to report four units of 19101 (Biopsy of breast; open, incisional) because the surgeon identifies four distinct breast lesions and four separate excisions in the op report. If Medicare is the payer, your problem might be the Medically Unlikely Edit (MUE) limit of three for 19101. If your surgeon documents distinct procedures at different sites that exceed the MUE limit...

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