Don't have a TCI SuperCoder account yet? Become a Member >>

Regular Price: $24.95

Ask An Expert Starting at $24.95
Have a medical coding or compliance question? Don’t sacrifice your valuable time to endless research. Choose Ask an Expert to get clear answers from the TCI SuperCoder team. And here’s a tip for the budget-conscious: Select the 12-question pack to get the best rate per question!

Browse Past Questions By Specialty

+View all

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..

99212 25
90472 X 3

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,

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.

Related Topics