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20th Sep

MUE

What Does That Stand For?

 

We live in a world full of acronyms. LOL, BRB, COT, MDS, ADL, PUF, PEPPER, and the list goes on!

So, what does MUE stand for? Medically Unlikely Edits

What does this mean? CMS developed MUEs to decrease the paid claims error rate for Part B claims. This is the maximum units of service (HCPC/CPT code) that a provider can report under most circumstances per patient, per date of service. This was implemented January 1, 2007 and has been utilized to adjudicate claims. Not all HCPC/CPT codes have an MUE.

Why are these important? If these MUEs are not followed correctly, claims will deny. This is how it works. Since MUEs are edits, when the facility submits a claim, there are many edits in the CMS software to ‘scrub’ the claim, if you will, to see if the claim is “clean” for processing. If they get a “hit” on the edits, then the claim will go through to see if the claim matches the edits and if not, the claim item(s) will deny. This process happens when the claim is submitted for payment. The edits can identify when a KX and/or -59 modifiers are not applied to the claim, or diagnoses are not on the claim, or the revenue code is incorrect, etc.

How does this relate to therapy? Well, therapists provide therapy care and they bill for that care. Business Office Managers will need to bill per line item and attach the -59 modifiers to avoid denials.

This table below outlines some frequently used therapy CPT codes, the code description, how many units can be billed over dates of service. Let’s take a look:

CPT Code CPT Code Description Number of Units Number of days
92507 Speech Treatment 1 3 Date of Service
92610 Dysphagia Evaluation 1 2 Date of Service
92526 Dysphagia Treatment 1 2 Date of Service
97012 Mechanical Traction 1 3 Date of Service
97018 Paraffin 1 3 Date of Service
97022 Whirlpool 1 3 Date of Service
97024 Diathermy 1 3 Date of Service
97032 Electrical Stimulation, constant attendance 4 3 Date of Service
97035 Ultrasound 2 3 Date of Service
97110 Therapeutic Exercise 8 3 Date of Service
97112 Neuromuscular Re-education 6 3 Date of Service
97116 Gait Training 4 3 Date of Service
97124 Massage 4 3 Date of Service
97140 Manual Therapy 6 3 Date of Service
97150 Group Therapy 2 3 Date of Service
97161; 97162; 79163 PT eval 1 2 Date of Service
97164 PT re-eval 1 2 Date of Service
97165; 97166; 97167 OT eval 1 2 Date of Service
97168 OT re-eval 1 2 Date of Service
97530 Therapeutic Activities 6 3 Date of Service
97532 Cognitive Skills Retraining 8 3 Date of Service
97535 Self-Care Retraining 8 3 Date of Service
97542 Wheelchair Management 8 3 Date of Service
G0283 Electrical Stimulation, non-wound 1 3 Date of Service
97760 Orthotics Management & Training 6 3 Date of Service
97761 Initial mobility & functional activity training with orthotic/prosthetic 6 3 Date of Service
97762 Check for orthotic/prosthetic use; 4 3 Date of Service

For a full list of MUEs, click here for the link to CMS website.

Let’s look at an example. If therapy bills for more than 8 units of 97110 (therapeutic exercise) over 3 dates of service, the services that exceed 8 units will be denied if a -59 modifiers is not applied.

It’s important to understand how MUEs will affect your claim. If not, you will be SYH (Shaking Your Head)!

Gina Tomcsik

Director of Compliance

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