Question:
Why does the 2018 NCCI Policy Manual state that we can only charge for one venipuncture (36415) per patient encounter, but the MUE limit for 36415 is set at 2 per date-of-service?
Answer:
The medically unlikely edit (MUE) is set so in the event a patient is seen two different times for outpatient encounters the provider can report each specimen collection. For example, in the morning, labs are drawn for chronic conditions, and separate labs are drawn later in the same day for an emergency department visit. The MUE is set to allow for billing of venipunctures at separate or distinct encounters.
CPT® copyright 2024 American Medical Association (AMA). All rights reserved.
Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
CPT is a registered trademark of the American Medical Association.
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