Wiki 78452-26?

[Jfrank]

We are reciving denials for using 78452 with modifier 26. I've been looking for an answer for 2 days now and haven't seen it referenced here yet. We are being told you can't split the code with a 26. Is there a more appropriate code just for reads?
The tests are preformed in the hospital and the reads are done in his office.

 

[agott]

I had a conversation with Medicare yesterday and was told if you have a 21 or 22 POS then the 78452 with 26 modifier will process correctly if you have a 11 POS they are stating that you can not separate the code.
I was getting a rejection regarding the 78452 stating invalid POS, we read the test for a outpatient testing center, and they stated that because it was a 22 POS I needed a 26 modifier on the claim, which I thought I had but did not. And that was when she told me about the POS situation. Hope that helps.

 

[cmcgarry]

Even though the reads are done in his office, you still use the hospital location and the -26 modifier, because the tests were done at the hospital. That should help with the denials.