New claim edit: The MJ unit of measurement code is only valid for anesthesia services

Stedi now rejects 837P professional claims when the MJ (minutes) unit of measurement code is used to incorrectly bill for anesthesia or non-anesthesia services.

In professional claims, the MJ unit of measurement code indicates a service was billed in minutes. While not a HIPAA mandate, it’s standard practice in the healthcare industry to bill for anesthesia services - but no other services – using MJ. Other services are billed using units, encounters, or time-based units – such as 15-minute increments – not raw minutes.

If MJ is used incorrectly, payers may reject the claim, which can lead to payment delays. This edit – the industry’s term for an automated validation rule – catches the issue before it reaches the payer.

When MJ must be used

An 837P professional claim will fail this edit when it contains a service line where all of the following are true:

• The procedure code is a CPT code in the range of 00100-01999, indicating it’s related to anesthesia.

• An anesthesia-related procedure modifier, as defined by the American Society of Anesthesiologists, is present. These modifiers include:

  • AA – Anesthesia services performed personally by an anesthesiologist

  • AD – Medical supervision by a physician; more than 4 concurrent anesthesia procedures

  • G8 – Monitored anesthesia care [MAC] for deep complex, complicated, or markedly invasive surgical procedure

  • G9 – Monitored anesthesia care [MAC] for patient who has history of severe cardiopulmonary condition

  • QK – Medical direction of 2, 3, or 4 concurrent anesthesia procedures involving qualified individuals

  • QS – Monitored anesthesiology care services

  • QX – Qualified non-physician anesthetist with medical direction by a physician

  • QY – Medical direction of one qualified non-physician anesthetist by an anesthesiologist

  • QZ – CRNA without medical direction by a physician

• The unit of measurement code is not MJ.

If you submit a claim that fails this requirement using Stedi’s 837P professional claim submission APIs or CMS-1500 professional claim form, you’ll get back an error message in real time. If you’re using the JSON API endpoint, the response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": Invalid Measurement Code for Anesthesia Procedure Code. 01001 is an Anesthesia service which must be reported in minutes (measurement code: MJ). Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails this requirement using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will contain a related claim status category code, claim status code, and error message. You can use the error message to correct and resubmit the claim.

When MJ must not be used

An 837P professional claim will fail this edit when it contains a service line where all of the following are true:

• The procedure code is not in the range of 00100-01999, indicating it’s not related to anesthesia.

• No anesthesia-related procedure modifiers are present.

• The unit of measurement code is MJ.

If you submit a claim that fails this requirement using Stedi’s 837P professional claim submission APIs or CMS-1500 professional claim form, you’ll get back an error message in real time. If you’re using the JSON API endpoint, the response includes details in the errors array:

{
  "errors": [
    {
      "code": "33",
      "description": Invalid Measurement Code for Procedure Code. Measurement Code MJ is not valid for 90837 as it should be only used code for Anesthesia services. Correct and resubmit.",
      "followupAction": "Please Correct and Resubmit"
    }
  ]
}

If you submit a claim that fails this requirement using SFTP, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will contain a related claim status category code, claim status code, and error message. You can use the error message to correct and resubmit the claim.