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78452, stress test

  1. #1
    Barren River Kentucky Chapter
    Unhappy 78452, stress test
    Exam Training Packages
    Can someone please help, I have been trying to figure out what the code that replaced 78452 in the nuclear stress test is for medicare and medicaid. normally we charge 93015 and 78452 however were informed that that is no longer valaid for mcr and mcd therefore have started using 93016, 93018 and am not just what to use in place of 78452 everything we have tried hasn't worked. any information would be greatly appreciated

  2. Default
    It is my understanding that when 78452 became the new code it replaced using 78465, 93015, 78478, 78480. We no longer bill the 93015 with the 78452 because it is now considered included in the main code.

  3. #3
    Are you billing for technical, professional or global services? We bill 78452, 93015 + meds when done in house. You have to use a -25 modifier on your E&M if done same day. If test done at hospital we bill 78452-26, 93016 and 93018.

  4. Default
    I don't know what I was thinking. In office, we do bill Medicare the 93015 with 78452 global charge and are getting paid on it. The office visit will get denied as now if you do not put a mod 25 on it.

  5. #5
    Barren River Kentucky Chapter
    i was talking about in hospital mostly, we also do them in office but are not having problems there just the hospial and we were told by mcr that they were no longer accepting the 78452 so i am confused

  6. #6
    We get paid by Medicare for CPT 78452-26 just fine. Anyone else having issues?

  7. #7
    I still bill out 78452-26 and haven't had any problems either..

  8. #8
    Barren River Kentucky Chapter
    i called and they stated that the denial is coming from my local and that they couldn't see a reason why but that they couldn't do anything about it I would have to contract my local and I can't get them to give me a direct answer

  9. Question 78452.26 and 93016 inclusive
    We billed 99291, 93016, 93018 and 78452.26. We have been paid on everythign except the 78452.26 stating it is inclusive to 93016. Should we have attached modifier 25 to 99291 or 93016 states that 78452 is included in the service... please help me.


  10. #10
    Alexandria, LA
    78452 and 93016 should be allowed. If your Medicare payer is denying - then appeal. Use the instructions in the CPT book (look at the guidelines before 78414 - where it tells you to use both code/s from 93015-93018 and 78451-78454. My guess is that they have a glitch in their system and until someone appeals high enough they won't fix it. You may have to go through the first couple of levels of appeals.

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