Our experts answer questions about hitting MUEs on injections and infusions, setting multiple prices for the same CPT codes, payment rates for cancer centers, and more.
Q: Our laboratory has been running some testing for “proprietary laboratory analyses” for colorectal and ovarian cancer. The codes they gave me are not active, but they said they are the testing codes provided by the manufacturer. The codes are 0002U and 0003U. Are these valid codes to report on a claim?
Q: We have claims that are hitting an edit between a procedure HCPCS code and the new codes for moderate sedation (99151–99153). Since moderate sedation is no longer inherent in any procedure beginning January 1, why are these scenarios hitting an edit?
Q: OCR has said that the comprehensive HIPAA audits will occur in 2017. We received a pre-audit letter as a CE but were not audited as part of the CE round of phase two desk audits. What is included in the comprehensive audits, and is there a chance we will be audited?
