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Vaccine Adm Codes processed as duplicate

Patti Posted Tue 25th of November, 2014 20:01:25 PM

We are pediatricians who give multiple vaccines to a single patient at one visit. The CPT code 90461 is for additional components. Our problem is that the insurance companies are paying only one vaccine and processing the rest of the vaccines on the HIFCAs as duplicates. We tried sending a letter to tell them the charges are not duplicates, they are for other vaccines.

For example: We did a 6 mo old well exam 99381-25 and charged (during the pentacel shortage)
90700 aDPT, 90460 paid 90461 quantity 2 paid
90713 IPOL, 90460 Duplicate
90648 Hib, 90460 Duplicate
90670 Prevnar 90460 Duplicate

It is very time consuming to call each insurance company. Can you please help?

SuperCoder Answered Wed 26th of November, 2014 07:32:46 AM

Your coding is correct. You should appeal the denial.

Thanks !!

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