Page 1 of 2 12 LastLast
Results 1 to 10 of 12

Need help with 78452 w/26

  1. Default Need help with 78452 w/26
    Medical Coding Books
    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.
    The tests are preformed in the hospital and the reads are done in his office.

  2. #2
    Location
    Jacksonville Florida
    Posts
    126
    Default
    Quote Originally Posted by Jfrank View Post
    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.
    The tests are preformed in the hospital and the reads are done in his office.
    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?
    Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA

  3. Default
    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.

  4. #4
    Default
    Hi, did anyone find an answer to this question yet? We are having the same problem with denials due to modifier 26.

  5. #5
    Default
    I just got my first denial today for 78452-26 (from United Health) Ugh!

  6. #6
    Location
    Jacksonville Florida
    Posts
    126
    Default
    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
    Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA

  7. #7
    Default
    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.

  8. #8
    Default 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

  9. #9
    Location
    Jacksonville Florida
    Posts
    126
    Default
    CMS took that rule back

    http://www.cms.hhs.gov/transmittals/...ds/R1873CP.pdf

    They haven't released a new transmittal yet on billing the POS/DOS changes.
    Jammie Barsamian, CPC, CCC, CEMC, CCS-P, CPMA

  10. Default
    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

Page 1 of 2 12 LastLast

Similar Threads

  1. 78452 denial
    By smartcoder in forum Cardiology
    Replies: 3
    Last Post: 03-02-2014, 05:28 AM
  2. Query on 78452
    By prabha in forum Interventional Radiology
    Replies: 4
    Last Post: 12-16-2011, 05:28 AM
  3. 78452 93016
    By mcgraws in forum Cardiology
    Replies: 4
    Last Post: 10-19-2011, 01:41 PM
  4. cpt 78452
    By pdrgos in forum Cardiology
    Replies: 0
    Last Post: 07-15-2010, 07:32 AM
  5. 78452-26?
    By Jfrank in forum Medicare Regulations
    Replies: 2
    Last Post: 02-16-2010, 03:10 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.