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78452 93016

  1. Default 78452 93016
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    Our office billed 99291, 78452.26, 93016 and 93018. The payor is Blue Cross. THe ins paid everything except 78452.26. THey say it is inclusive to 93016. Should have I added a modifier to 99291? Help please!

  2. #2
    Location
    Richardson, TX
    Posts
    822
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    When we billed the nucs in the office we didn't put a 26 on them. Did they say mod was incorrect? I'm thinking that COULD be why.
    Julie Graham, BA, CPC, CCC

  3. Default cardiology coding
    i m just start to study for cardiology coding. i there seminar watch on for studying

  4. Default
    78452-26 Is the read of a stress, so is 93016, the difference is 93016/93018 is performed in a facility, 78452 stresses are what we bill for office stresses, so 78452-26 is an office stress read. You should not bill 78452-26 and 93016 for the same encounter.

  5. #5
    Location
    Alexandria, LA
    Posts
    518
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    Quote Originally Posted by Jfrank View Post
    78452-26 Is the read of a stress, so is 93016, the difference is 93016/93018 is performed in a facility, 78452 stresses are what we bill for office stresses, so 78452-26 is an office stress read. You should not bill 78452-26 and 93016 for the same encounter.
    This is incorrect. If you have a CPT book, look at the guideline before 78414. It tells you that it is correct to code both 78452-26 and 93016 (when the same doctor provides both services)

    78452-26 is the interpretation of a nuclear medicine myocardial perfusion study. 93016 is supervision of the actual stress test. 93018 is the interpretation of the stress test. Neither the supervision, nor the interpretation of the stress test is included in the interpretation of the nuc med study. The interpretation for 78452 may reference the stress test, but the formal interpretation is separately coded.
    More often than not different doctors interpret these, but if one does both, he should code both.

    Having said that, BC may have their own internal edit that bundles these codes. I would appeal it using the guidelines in CPT and showing clear separate interpretations.

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