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Billing both flu and pneumonia vaccines at same visit with 99214 (unrelated)

Debra Posted Sat 18th of January, 2020 00:57:31 AM
Billed 2 vaccines; 90732 90686 with g0009 and g0008. Also with a visit 99214 for wound care and med mangement. All codes adjusted off except for G0009 code-it was paid. I assume a modifier issue: 25 on 99214 and 59 on all other codes. Should the vaccines and G codes not have modifiers? Or only one of the G codes have a modifier? Would the vaccines themselves need modifiers? This entire billing game is an embarrassment to our profession.
SuperCoder Answered Mon 20th of January, 2020 07:16:08 AM

Hi Debra,

 

Thanks for your question.

 

To find answers to all your questions and to clear confusion in billing of such scenarios, please read the following tips carefully. Also please correlate these with your medical record. If you still feel that your documentation is different, then we would request you to let us know the reason code provided by the insurance stating the reason of not paying these codes.

 

TIP 1: When coding for immunizations, report separate codes for vaccine administration, the actual vaccine, and an office visit. Include sufficient documentation from your provider explaining the product administered, administration route, and purpose. If the patient has vaccines as part of a preventive medicine service, include the appropriate E/M code for the visit from 99381 to 99387, New patient preventive medicine services or 99391 to 99397, Established patient preventive medicine services. If the patient comes to office because of another problem and receives immunizations during the visit, report the vaccine with the appropriate office visit code from 99201 to 99205, New patient office or other outpatient services, or 99211 to 99215, Established patient office or other outpatient services. Some insurance companies require modifier 25, Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service, to be appended to the associated E/M code. If the health professional provides a significant, separately identifiable E/M service during the visit, documentation should support modifier 25.

 

Example: The patient experiences some nausea and vomiting after the injection, so your nonphysician practitioner, NPP, provides monitoring and treatment. You might be able to report modifier 25 with the E/M code. Do not append modifier 51, Multiple Procedures, to 90732 when performed with another procedure. Don't report two or more initial administration vaccine codes during the same visit. Instead, report an initial code for one vaccine and subsequent administration codes for other immunizations. Medicare and private insurance companies might have different guidelines for reporting any vaccines, or for reporting certain vaccines during the same visit, such as flu and pneumonia vaccines. Check with the individual payers for their specific guidelines. Be sure to have the policy in writing to protect your practice in the event the payer questions your modifier use which is not consistent with CPT® guidelines.

 

TIP 2: You may also need to select from other forms of this vaccine in the section, Vaccines, toxoids (90476 to 90756). When coding for immunizations, report separate codes for vaccine administration, the actual vaccine, and an office visit. Include sufficient documentation from your provider explaining the product administered, administration route, and purpose.

 

TIP 3: The Healthcare Common Procedure Coding System, or HCPCS, codes that begin with a G identify professional health care procedures and services that would otherwise be coded in CPT® but for which there are no CPT® codes. When billing for administration of the pneumococcal vaccine for Medicare and payers that follow Medicare rules, use G0009, Administration of pneumococcal vaccine. When billing for administration of the pneumococcal vaccine for other commercial payers, you may need to use 90471, Immunization administration includes percutaneous, intradermal, subcutaneous, or intramuscular injections; 1 vaccine, single or combination vaccine or toxoid. Check with the individual payer for their reporting requirements. Pneumococcal conjugate vaccine, 7 valent, for intramuscular use, 90670; Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use and, 90732; Pneumococcal polysaccharide vaccine, 23 valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use.

 

TIP 4: The Healthcare Common Procedure Coding System, or HCPCS, codes that begin with a G identify professional health care procedures and services that would otherwise be coded in CPT® but for which there are no CPT® codes. When billing for administration of the influenza virus vaccine for Medicare and payers that follow Medicare rules, use G0008, Administration of influenza virus vaccine. When billing for administration of influenza virus vaccine for other commercial payers, you may need to use 90471, Immunization administration includes percutaneous, intradermal, subcutaneous, or intramuscular injections; 1 vaccine, single or combination vaccine or toxoid. Check with the individual payer for their reporting requirements. Report the actual vaccine separately, using the range of code Q2034 to Q2039.

 

Hope this helps.

 

Thanks.

Debra Posted Thu 06th of February, 2020 15:40:16 PM
I need to know if the vaccines and the G codes need a modier? I know the 99214 will need a 25.
SuperCoder Answered Fri 07th of February, 2020 03:42:36 AM
nbsp Codes G and G are report to Medicare only Reporting the code for the supply of the vaccine i e is also appropriate There is no CCI edits between these So there is no need to append modifier We request you to provide us the reason of denial provided...

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