Resolved Question about MUE with finger CPT Codes

[WendyH_53178]

A co worker and I are at odds over MUE over certain codes and how they can be billed for our orthopedic hand surgeons.
CPT code 26145 shows MUE of 6 units. I am saying that 6 is the maximum number of units to be billed per day. My co-worker is stating that you can bill up to 6 units per day for each finger modifier that it shows on Codify, Encoder, etc .
I was always under the impression the modifiers are there as a guide and not as a per unit.
Same goes for CPT code 26440- description says each tendon with MUE of 6. She states we can bill 26440 F1 -6 units 26440 F2- 6 units Etc.... Where I on the other hand say you can bill 26440 with the modifier that represents the finger or hand up to a maximum of 6 total.
Our doctor is stating that they did in fact do more than 6 so we can bill it. I’ve tried explaining CMS and that they have the final say, but they feel it is not a concrete answer. I’ve also explained once it hits the clearinghouse it will be denied for maximum units. Am I misinterpreting this ? I hope this makes some sense. We are at odds and unable to come to a clear answer.

 

[Alicia]

You are right about the clearing house. They often change things and without the provider knowing.
26145 - Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon

This procedure is performed to treat inflammation of the synovial tissue in the tendon sheath caused by conditions such as rheumatoid arthritis. A skin incision is made over the affected tendon in the palm or finger. Overlying tissues are dissected and the tendon sheath exposed. The tendon sheath is incised and inspected. All inflamed synovial tissue is removed using a motorized suction shaving device. Report 26145 for each separate tendon sheath treated on which a radical tenosynovectomy is performed.

The thing is that CMS things that you can't do that many. Bill it like you said then be ready to appeal it. Or you can send the documentation in as a special report. Either way you do it like you or your co-worker stated it will be denied. If it is not changed at the clearing house.