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Modifiers for the office visit with vaccines

Patricia Posted Mon 28th of January, 2013 20:27:48 PM

Thank you for your below answer, for this helps. Sorry I could not find how to reply to the original message. I would like to know if this includes sick visits also?

You are correct saying that this is a change to 2013 coding. Indeed, 2013 has brought a CCI relationship change between these two codes - 99381-99395 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 99381/95 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.

SuperCoder Answered Tue 29th of January, 2013 17:48:31 PM

Yes, unfortunately the sick visit codes (99201-99215) are also bundled into the vaccine codes based on CCI 19.0. You’ll have to append modifier 25 to your E/M visit code and you won’t need any modifier on the vaccine.

Patricia Posted Tue 29th of January, 2013 20:06:47 PM

Thanks so much for your help.

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