CPT® code 78452

Hi, I have billed 99235 on one claim and 78452,93016,93018 on the other claim for same date of service..I received denial for 78452 from commerical insurance (cigna) stating "this procedure code presents services integral to the more complex primary procedure performed on the same date of service and submitted on a separate claim". I think insurance is stating that both 99235 and 78452 must not be done on the same date of service. I checked these codes in ncci edits (99235,78452,93016,93018), it states that a modifier is required for 99235 nothing for 78452...I got paid by insurance for 99235,93016 and 93018 except 78452..So can anybody suggest me the correct way of billing these codes when done on the same date of service, so that i can get paid for all the four codes...

Good day!
Anitha

re: CPT® code 78452

Sorry i missed one thing, i billed 78452 with modifier 26

re: CPT® code 78452

78452 needs mod 59. The E/M code and 78452 are considered bundled. As long as the notes support it, you can unbundle. Cigna has a claim audit program on their web-site for providers, it's very handy. For example, you may add 59 to the code, and they'll pay it but then recup the E/M payment, in which case it needs a Mod 25 also.

re: CPT® code 78452

Thank You!