Wiki Denial of 78452 while in Obs status

[4christina.hanson@gmail.com]

Good Morning all,

My physicians read nuclear stress studies for the local hospital while they are on call. In the past few weeks I have received denials from Cigna, UHC, and Humana stating that CPT 78452 code requires authorization. I called the hospital and they told me these patients are in observation status and they are unable to get authorizations for any other services. I have appeal but have been denied on every case. Has anyone else had this occur or any solutions I can try to get reimbursement for my physicians?

 

[heartyoga]

Hi Christina,
I just read your post. We had this problem also. For Humana, you can request retro prior auth from the ordering doctors. For UHC, Cigna sometimes we ask the hospital to inform us, or the doctor looks at the ins and call our office to preauth it. 23 hr observ stay is really tricky bec POS is outpatient so ins computers are reading it as outpt like ordered from ofc. For BCBS, as long as they are admitted through the ER w chest pain, SOB, etc cardiac related, I call BCBS and tell them that they were admitted through ER and they usually reprocess. Hope this helps. Private message me so we can share experiences and solutions.