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99396 pe codes with vaccine admistration code 90471- 90460 question modify use

If you are billing out a 99396 with the administration of vaccine 90471 would you append a 25 modify to the PE or would you append a 59 modify to the administration code. After looking at the coding instruction in the 2019 book questioning the use of the 25 Modify on PE with administration of vaccine. The coding book seems to show in the Medicine section that the correct modify for this is 59 on the administration. The PE section shows that 25 should only used when trying to show that another EM code is being billed. Several payers if you apply no modify will pay the administration code and bundle not pay the PE. Question is what is the correct modify with this 25 on the PE or the 59 on the 90471?

Medical Billing and Coding Forum

Billing 96372 and a 90460 on same claim

I billed an E&M and an injection. Pt also receive a vaccine. It went like this: 99214 w/25 Mod, J1885, 96372, 90715, 90460 w/59 mod. Ins denied 96372 saying it was incidental to 90460 though it had a 59 modifier. Ins says the denial is based on Mckesson Clear Claim guidelines. What the heck is that?! Can anyone tell me where I went wrong?

Medical Billing and Coding Forum

90460 denials from McKesson edits

We recently got a denial from Cigna disallowing the 90460 when billed with 90651. They use the Clear Claim Connection through McKesson and when I went on there it also disallowed the code.

We billed
99394-25
90651
90460

This is the way we have always billed it but the edit response McKesson give is:
Response:
According to CPT guidelines published by the AMA, "Codes 90476 – 90748 identify the vaccine product only. To identify the administration of a vaccine/toxoid, the vaccine/toxoid product codes 90476-90748 must be used in addition to an immunization administration code(s) 90460-90474." In addition, according to CMS, codes G0008 – G0010 represent vaccine administration only. Thus, these codes may also receive a recommendation for denial when submitted without their primary vaccine or toxoid supply code.
This claim line was recommended for denial because the vaccine product code was not submitted with the appropriate associated vaccine administration code.
Therefore, procedure 90460 is disallowed.

Anyone having this issue or can assist in understanding why and what to do?

Medical Billing and Coding Forum

90460 +90461

I attended a webinar for Sanofi and they they were actually explaining how to bill and get reimburse for VCF vaccines.

so example MMR vaccine would be billed as follows;
90707 (3 components)
90460 x2
90461 x1

and other example
90697 (6 components)
90460 x1
90461 x5

so we are getting paid base on the components of the vaccine? So my provider thinks if we give 1 vaccine we would bill for 1 administration code and 1 vaccine regardless of the components.

i need clarification maybe examples please help

Medical Billing and Coding Forum