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Coding w/multiple modifiers

Tina Posted Tue 06th of December, 2016 15:05:35 PM
How can we bill out for two procedures that are requiring a 25 modifier? For example, Patient John Doe is being seen for sinusitis, allergic rhinitis, and a cough. The doctor ordered an allergy test for the allergic rhinitis diagnosis. The doctor also ordered the patient to receive a Flu shot. Normally, I will bill the office visit code and the allergy test code placing a 25 modifier on the office visit. However, this patient is also getting vaccines. I was told I can only use 25 modifiers once. How do I bill for the allergy test, office visit, and the vaccine with the administration code without the insurance company frowning upon me! What is the proper way, if any, to code this visit? When is it ok to use modifier 59?
SuperCoder Answered Wed 07th of December, 2016 02:19:09 AM

Greetings from SuperCoder.com!

 

In this case, you should bill as follows:

 

  1. Office visit codes (e.g. 99213). It has CCI edit with Allergy testing codes (e.g. 95017). So append modifier 25 with office visit code.
  2. Immunization administration codes (e.g. 90460).
  3. Allergy testing codes (e.g. 95017).
  4. Influenza virus vaccine/flu shot (e.g. 90662).

 

Please note that codes mentioned here are just for examples. You should check your documentation for proper billing.

 

Please feel free to write if you have any further questions.

 

Thanks.

 

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