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billing vaccine with adminstration

Aida Posted Wed 11th of June, 2014 09:37:50 AM

I was wondering if there has been any changes to billing the vaccines with the administration.

Examples of what we bill without office visit:
90723
90471
90472
90670
90472
90648
90472
90633
90472
90680
90474

We have been advise that we are billing it wrong. Where can we search for more information. We have tried researching and unable to find any information. Please advise

SuperCoder Answered Wed 11th of June, 2014 14:32:49 PM

Hi there - I'm not aware of any major recent changes in vaccine billing - can you tell us what your payer is saying you did wrong? Do you bill any modifiers?

Aida Posted Thu 12th of June, 2014 10:18:51 AM

its was with Texas Medicaid and there were not modifier, since it was only the immunization that were given, no office visit.

SuperCoder Answered Thu 12th of June, 2014 16:34:05 PM

Is the list above exactly how you report it? Most of these codes can be billed together without an issue, but I noticed, for example, that 90472 is listed multiple times...some payers want you to report 90472 x the number of units rather than billing it with multiple line items (because they'll reject the subsequent line items as duplicates). Others want modifier 59 on it, and still others will only pay it up to twice per submission. You should contact your Medicaid provider and ask for specific instructions about how to report these vaccines when provided together, because unfortunately each insurer has separate guidelines.

Torrey Kim, CPC

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