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Changes for the 2013 New Year.

Patricia Posted Sun 27th of January, 2013 21:32:38 PM

Part I:
I am getting denials for all of my office visits when paired with vaccine administrations, whether it be a sick, well preventative, or new patient. Can you please let me know what is going on? Do we need to append the 25 modifier now, although it has never been required prior to this. We are at a lost. Please let me know.

Part II:
We are also getting denials on office visits with screenings? If I have a sick patient and or new patient due for a hearing and vision screening, they are paying for the hearing screen and denying the vision. I am so confused...........


SuperCoder Answered Mon 28th of January, 2013 17:42:50 PM

You are correct saying that this is a change to 2013 coding. Indeed, 2013 has brought a CCI relationship change between two codes - 99391 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 99391 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.

Patricia Posted Mon 28th of January, 2013 23:21:52 PM

Thank you. Does this apply for the 90471/90472 & 90473/90474 also?

SuperCoder Answered Tue 29th of January, 2013 04:20:51 AM

Yes, the same principle applies to 90471/472/473/474 also in 2013.

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