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Thread: 78452-26?

  1. #1

    Angry 78452-26?

    AAPC: Back to School
    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.

  2. #2
    Join Date
    Apr 2007


    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.

  3. #3
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    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.
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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