Appeal Requests to Change the Quantity Billed

When billing the quantity of services provided to the patient, correct placement of numbers in the quantity billed (QB) section can be crucial for proper claim processing.

The QB section of a claim should be five spaces, with no decimal points, i.e., 00000. This is considered four whole numbers and fractional number, i.e., 0000.0.

When billing whole units, the QB should be entered ending in 0. For example, if you are billing for two injections your units of service would be 00020 or one office visit would be 00010. 

Claims for ambulance mileage, anesthesia services and some drugs may need to be billed using fractional amounts in the QB field. For example, 12.5 miles = 00125 as in 0012.5 or 88 minutes of anesthesia time is billed 00059 for 0005.9 units.

Did your claim not pay for the number of units expected?
The most common billing errors we see is the QB/Units field was billed incorrectly.

Consider units versus minutes:
15 minutes of anesthesia would be billed as 1 unit, not 15; 60 minutes would be billed as 4 units, not 60. Sometimes fractional billing is necessary. 88 minutes of anesthesia time should be billed 5.9 units (00059).

Consider the amount in the code description:
HCPCS code J1020 description is injection, methylprednisolone, 20 MG. Each 20 MG would be billed as one unit. 100 MG of methylprednisolone would be billed as 5 units. If 100 MG are given, that is divided by 20 MG (for 1 unit of HCPCS code J1020) = 5 total units given and should therefore be billed as 5 units. 

Remember to end whole numbers with a 0 (zero):
Codes billed in whole units need to end in a 0 (zero) to avoid fractional billing. When billing things like mileage, units should be entered ending in 0 to reflect no fractional charges, i.e., 10 miles = 00100, whereas fractional charges would include the last space, i.e., 12.5 miles = 00125 as in 0012.5.

How to Appeal an Underpaid or Denied Claim
First, check what was submitted. Often the QB field was not entered correctly and just needs to be changed. If you find this to be the case, you may qualify for a reopening request.

Second, check to be sure that the quantity you are billing falls within the MUE value allowed, for those with published limits. MUE limits can be found on the CMS website. For more information refer to the download section at the bottom of this CMS web page.

When appealing a claim that has been paid incorrectly or denied completely, documentation must be submitted to support that the number of services billed were performed and that all the services were medically necessary. This is true for units up to and over the MUE value as well.