Go Back   AAPC Medical Coding & Billing Forums > Medical Coding > Cardiology
Forum Rules FAQ Members List Calendar Search Today's Posts Mark Forums Read

Reply
 
Thread Tools
  #1  
Old 06-15-2011, 10:32 AM
MFaulkner MFaulkner is offline
Networker
 
Join Date: Apr 2007
Location: Barren River Kentucky Chapter
Posts: 34
MFaulkner is on a distinguished road
Unhappy 78452, stress test

Can someone please help, I have been trying to figure out what the code that replaced 78452 in the nuclear stress test is for medicare and medicaid. normally we charge 93015 and 78452 however were informed that that is no longer valaid for mcr and mcd therefore have started using 93016, 93018 and am not just what to use in place of 78452 everything we have tried hasn't worked. any information would be greatly appreciated
Reply With Quote
  #2  
Old 06-15-2011, 11:35 AM
rbrister rbrister is offline
New
 
Join Date: Apr 2007
Posts: 9
rbrister is on a distinguished road
Default

It is my understanding that when 78452 became the new code it replaced using 78465, 93015, 78478, 78480. We no longer bill the 93015 with the 78452 because it is now considered included in the main code.
Reply With Quote
  #3  
Old 06-15-2011, 02:05 PM
amym amym is offline
Guru
 
Join Date: Apr 2007
Posts: 225
amym is on a distinguished road
Default

Are you billing for technical, professional or global services? We bill 78452, 93015 + meds when done in house. You have to use a -25 modifier on your E&M if done same day. If test done at hospital we bill 78452-26, 93016 and 93018.
Reply With Quote
  #4  
Old 06-16-2011, 12:52 PM
rbrister rbrister is offline
New
 
Join Date: Apr 2007
Posts: 9
rbrister is on a distinguished road
Default

I don't know what I was thinking. In office, we do bill Medicare the 93015 with 78452 global charge and are getting paid on it. The office visit will get denied as now if you do not put a mod 25 on it.
Reply With Quote
  #5  
Old 06-16-2011, 01:48 PM
MFaulkner MFaulkner is offline
Networker
 
Join Date: Apr 2007
Location: Barren River Kentucky Chapter
Posts: 34
MFaulkner is on a distinguished road
Default

i was talking about in hospital mostly, we also do them in office but are not having problems there just the hospial and we were told by mcr that they were no longer accepting the 78452 so i am confused
Reply With Quote
  #6  
Old 06-17-2011, 07:22 AM
amym amym is offline
Guru
 
Join Date: Apr 2007
Posts: 225
amym is on a distinguished road
Default

We get paid by Medicare for CPT 78452-26 just fine. Anyone else having issues?
Reply With Quote
  #7  
Old 06-28-2011, 02:22 PM
sslater sslater is offline
Networker
 
Join Date: Apr 2007
Location: Jonesboro
Posts: 47
sslater is on a distinguished road
Default

I still bill out 78452-26 and haven't had any problems either..
Reply With Quote
  #8  
Old 07-27-2011, 10:21 AM
MFaulkner MFaulkner is offline
Networker
 
Join Date: Apr 2007
Location: Barren River Kentucky Chapter
Posts: 34
MFaulkner is on a distinguished road
Default

i called and they stated that the denial is coming from my local and that they couldn't see a reason why but that they couldn't do anything about it I would have to contract my local and I can't get them to give me a direct answer
Reply With Quote
  #9  
Old 09-22-2011, 10:21 AM
mcgraws mcgraws is offline
Contributor
 
Join Date: Apr 2007
Posts: 18
mcgraws is on a distinguished road
Question 78452.26 and 93016 inclusive

We billed 99291, 93016, 93018 and 78452.26. We have been paid on everythign except the 78452.26 stating it is inclusive to 93016. Should we have attached modifier 25 to 99291 or 93016 states that 78452 is included in the service... please help me.

Confused
Reply With Quote
  #10  
Old 09-22-2011, 12:32 PM
donnajrichmond donnajrichmond is offline
True Blue
 
Join Date: Apr 2007
Location: Alexandria, LA
Posts: 517
donnajrichmond is on a distinguished road
Default

78452 and 93016 should be allowed. If your Medicare payer is denying - then appeal. Use the instructions in the CPT book (look at the guidelines before 78414 - where it tells you to use both code/s from 93015-93018 and 78451-78454. My guess is that they have a glitch in their system and until someone appeals high enough they won't fix it. You may have to go through the first couple of levels of appeals.
Reply With Quote
Reply

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off




Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

All times are GMT -6. The time now is 11:24 AM.

AAPC - Top

Powered by vBulletin® Version 3.8.1
Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.
Copyright ©2014, AAPC