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Sick with Well visit, and Vaccines.

Patricia Posted Thu 07th of February, 2013 17:24:54 PM

Just curious, for we are getting denials... Please let me know which modifier would be used in the below situation..

99392
99212 25
90471
90700
90472 X 3
90716
90713
90707
87086

I know the visits are column 2 codes... Just not sure if we should be putting the 25 modifier on both visits or now..

Thanks for your help,
Patricia

SuperCoder Answered Wed 13th of February, 2013 21:58:55 PM

Here's a note from AAP. Note that they suggest to check with individual payers for modifier preferences and edits:

NCCI Bundles Preventive Services with Immunization Administration in 2013
In the latest versions of the Medicare and Medicaid National Correct Coding Initiative (NCCI) edits, effective 01/01/2013, all evaluation and management (E/M) services including preventive medicine services (ie, 99381–99387, 99391–99397) are paired with codes for immunization administration (ie, 90460 – 90461, 90471–90474, G0008-G0010). This bundles E/M services with the immunization administration charges.
Per CPT instructions for use of modifiers, “To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.” You should append modifier 25 to the appropriate preventive medicine service code when also reporting vaccine administration (eg, 99392-25, 90460) for all claims submitted after January 1, 2013. Be sure to check with your private payers as well. Many follow NCCI edits.
The AAP is currently working on having this edit overturned.
http://coding.aap.org/authoringPreview.aspx?type=current

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