Wiki Need help with 78452 w/26

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Jfrank

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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? So far 2 ins companies are denying, but it is on cms fee schedule with a modifier 26. I'm Very confused.:eek:
The tests are preformed in the hospital and the reads are done in his office.
 
Jfrank said:
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? So far 2 ins companies are denying, but it is on cms fee schedule with a modifier 26. I'm Very confused.:eek:
The tests are preformed in the hospital and the reads are done in his office.
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Yeah, that doesn't sound right. We haven't seen any denials yet. But I'll keep a look out. Which two ins co are denying?
 
So far united and anthem. They are both saying while the 78452 is on their fee schedule, it can't be billed with 26. Not sure if it's a glich in their system or what. Medicare is paying.
 
UHC has a "glitch" in their system. They are suppose to be fixing it and reprocessing the claims that were denied by mistake. We are all billing the nuc's correct, so hopefully they will get it fixed soon and pay us :D
 
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.
 
78452-26

I live in FL I have billed for this as well but MCR B stated that it is where the interp is being read is POS you use ex: if he does it rught there in the hosp the POS is 22, in office or house POS 11 not matter if the patient is in the hospital and also, you bill for the date test is interp not the day the test is done. Hope this helps

Taralyn
 
What do you mean when you say you can't seperate the code? (78452) I thought it was a stand alone code and I am coding with POS 11, any new info to guarantee processing? Thanks, Gail
 
We are also getting denials from Medicaid also. Who knows?! Hopefully, the insurance companies (beginning with Medicare) will get this straightened out sooner than later!!
 
Gail, you always bill pos where the service took place. IF the procedure was done at the hospital then use 21 or 22 POS not 11. I've billed that code several times this year to several carriers and have had no problems.
 
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