General Question for the Week of December 11, 2017

General Compliance Question of the Week

Question:

Do anatomic considerations enter into CMS’s decision on the number of MUEs?

Answer:

Yes, anatomic considerations may limit units of service. For example, in the 2018 NCCI Manual, the Centers for Medicare & Medicaid Services (CMS) give the following examples:

  • The MUE value for an appendectomy is “1” since there is only one appendix.
  • The MUE for a knee brace is “2” because there are two knees and Medicare policy does not cover back-up equipment.
  • The MUE value for a lumbar spine procedure reported per lumbar vertebra or per lumbar interspace cannot exceed “5” since there are only five lumbar vertebrae or interspaces.
  • The MUE value for a procedure reported per lung lobe cannot exceed “5” since there are only five lung lobes (three in right lung and two in left lung).

 

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.