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Billing 99381-99395 with 90460 & 90461

Gustavo Posted Fri 25th of January, 2013 22:16:03 PM

As of the beginning of 2013 we began receiving rejections from one of our insurance carriers when billing codes 99381-99395 along with codes 90460 & 90461. We've never used any modifiers when billing these codes together and have never ran into a problem. All of a sudden the carrier is paying for the counseling & administration code but not paying for the well visit. Should we be billing the physicals with a 25 modifier when also billing for the counseling/administration of the vaccines that were given during the physical?

Gustavo Posted Fri 25th of January, 2013 22:17:11 PM

90460,90461

SuperCoder Answered Mon 28th of January, 2013 17:22:34 PM

You are correct saying that this is a change to 2013 coding. Indeed, 2013 has brought a CCI relationship change between these two codes - 99381-99395 and 99460 / 99461. Earlier there was no CCI bundling between these two codes. Therefore till 2012, you could bill both the codes together. But in 2013, these two codes are bundled with modifier indicator 1, with 99381/95 being the column 2 code. You need to add modifier 25 along with 99391. No modifier is required for vaccine admin. code (90460/90461) since that's column 1 code.
So this means even though the vaccine admin. code is bundled within the well-child exam code, you can override the bundling by using a modifier (25) along with the well-child code.

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