Desiree Posted Tue 01st of October, 2019 16:32:49 PM
90471--received several denials (commercial /govt payers) modifier 25 appended on EM.. Don't understand the difference between codes 90471 and 90460
SuperCoder Answered Thu 03rd of October, 2019 06:38:47 AM
There are two parts to this query.
Question 1. 90471--received several denials (commercial /govt payers) modifier 25 appended on EM.
Question 2. Don't understand the difference between codes 90471 and 90460
Please find below the answers for the queries:
Ans1. Modifier 25 should be appended with E&M code when the E&M has been performed for a separate identifiable condition, unrelated to the current condition. If the E&M has been performed for the current condition, then E&M code should not be billed.
In your case, if the reason for visit is pre-planned immunization administration, then E&M visit would not be coded separately. However, If the decision to administer immunization was taken on the date of the E&M visit, then E&M code along with drug administration code would be coded.
Ans2. CPT code 90471 and 90460 are immunization administration codes. CPT code 90460 is related to Immunization administration through 18 years of age with counseling by physician or other qualified health care professional whereas counseling is not part of CPT code 90471. This code is specific to administration only.
Hope provided information would be helpful.