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?
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Tag Archives: 90471
G0008 with 90471
Originally, Medicare paid for the E/M, flu shot and admin (G0008), and denied the tetanus shot/admin (90471). We sent in an appeal for the tetanus, so Medicare paid for the tetanus shot/admin but then took back the payment for G0008 only, saying the denial is due to incorrect/missing modifier.
I’ve read that we should have used -59 on the 90471, but then I also saw a post saying that they did that and was still denied. Then I came across a suggestion to append a G code.
Has anybody come across the same situation? Any suggestions on exactly what modifiers and to which codes it should be attached?
ETA: I did find that Medicare requires -AT for the tetanus admin, but then they paid for it without that.
Thank you!
BCBS denying mod 59 on vaccine administration code 90471
Recently, we have gotten several denials from various BCBS plans for modifier 59 on vaccine administration code 90471. The remark code says "procedure modifier was invalid on date of service". One patient called BCBS and was told modifier 59 is invalid on this service. Is this a glitch within BCBs or has something changed with modifier 59 guidelines? I’ve searched online and can’t find any changes where I should not be allowed to use modifier 59 on the administration codes. Example of charges:
99215 mod 25
90670-for pneumonia vaccine medicine
90471 mod 59 for vaccine admin code
90471 vacine Administration and -59 modifier
Hello,
Would someone please help me with the 90471 vaccine administration and the-59 modifier question?
I am applying-59 modifier to the 90471 vaccine when the vaccine was given. However, I heard that since November 2017 this modifier should not be applied to the 90471 administration code. Is that correct? I tried to research but what I found is that only BCBS has that policy for not appling -59 to 90471 vaccine administration code. Can you please provide the guidance website or article if that is possible?
Thanks,
Benka
Would someone please help me with the 90471 vaccine administration and the-59 modifier question?
I am applying-59 modifier to the 90471 vaccine when the vaccine was given. However, I heard that since November 2017 this modifier should not be applied to the 90471 administration code. Is that correct? I tried to research but what I found is that only BCBS has that policy for not appling -59 to 90471 vaccine administration code. Can you please provide the guidance website or article if that is possible?
Thanks,
Benka
90471 and 90472 to code together or not to code together
When coding and billing for Dtap or Tdap without counseling for age 18 and under and for age 18 and above, what is the norm or the correct way to bill the insurance for this injection.
90471 + 90472 x2 or just bill for 90471 only?
What is the correct and the best practice in the industry?