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.

 

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