Wiki 78452 issue with Anthem

[metzger130]

We have been billing 78452 -26 for our physicians for years with no issues, now all of a sudden Anthem is denying our claims as "The place of service indicated on the claim isn't appropriate for CPT" for our claims when a patient has this done outpatient (eg observation status). Is anyone else having these issues and have you heard anything changed this year? I called anthem twice, 1 person said that things have changed and the other said there were no changes for the year. I have looked online and can't find anything with the code and place of service changes.

Thanks!
Rob

 

[mitchellde]

The POS would be outpatient if that is where the exam took place. So if you are using 22 then you are correct.

 

[j.monday7814]

we bill these quite often as well (inpatient and outpatient) and have not had a problem with any of our payers