Deborah Posted Tue 17th of January, 2012 19:24:37 PM
Blue Cross does not like G0008 and G0009
SuperCoder Answered Wed 18th of January, 2012 18:08:45 PM
Before assuming this, let's I request you check the following:
1. If the sole purpose for the visit was to receive the influenza virus vaccine or if the influenza virus vaccine is the only service billed on a claim, the provider must report diagnosis code V04.81. However, if the purpose of the visit was to receive both the influenza virus vaccine and the pneumococcal vaccine,Medicare providers must report diagnosis code V06.6.
2. If BCBS has a certain frequency of coverage(as once per year per Medicare), and the beneficiary requests vaccination more than the coverage during the same time, and the BCBS provider could not justify the medical necessity for the 2nd vaccination, then there will be a denial
Deborah Posted Thu 19th of January, 2012 21:14:18 PM
The flu and pneumonia vaccine are always given at the time of the visit. We bill 99213 for the visit, then Q2038 diagnosis V04.61. Then we bill G0008 with diagnosis of V04.61. For pneumonia we bill 90732 diagnosis V06.6 and then G0009. They will pay for the Q2038 and the 90732, but not for the G codes. They have always paid for them in the past. Medicare pays for them with no problems... And we alwasys check to make sure they have not already had one..
Carolyn Answered Thu 19th of January, 2012 23:03:15 PM
Why aren't you billing the vaccine administration codes to Blue cross? 90471 and 90472 The Q and the G codes are for medicare we bill all other payers with CPT codes not HCPCs.