:confused: And so I am starting to get a handful of claims that are not paying the preventative portion of the visit. For example, I bill 99392, 90460, 90686 and 99213-25. The child is here for a well visit but there is a separate and identifiable issue that the physician addresses and treats. Now I am seeing CCI edit denials stating the 99392 and the 90460 are inclusive and getting paid only for the admin, flu vac and the 99213. This is not limited to the flu, it is happening with other vaccines also. Have been doing this a few years now and this is just starting to come up.
Has the guideline changed that you can only use 25 once on a visit and it is always on the E/M code? would there be any other way to modify it?? I have searched for some clear guidelines but don’t find anything new. Any help would be greatly appreciated!