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Old 03-18-2011, 08:07 AM
dballard2004 dballard2004 is offline
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Default Vaccines/Well-Child Visit

The CPT guidelines state that if you have a significant, separately identifable E/M service in conjunction with vaccines, you report the E/M code with modifier 25. CPT gives an example in this case of either an office/outpatient E/M service or a preventative medicine service.

My question is this.....if a child presents for a well-child visit and we administer vaccines as part of the visit, do we report modifier 25 on the preventative E/M code? Are others doing this, or is this going to be payer specific? Thanks.
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Old 03-18-2011, 09:10 AM
driecam@yahoo.com driecam@yahoo.com is offline
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If the visit is specifically for Wellness...you should be using the proper E/M code for wellness, no modifier needed. Vaccines are billed with the appropiate administration codes w/ the vaccine (90471, 90472)...if the child has a seperate, identifiable illness...maybe a cough or runny nose, if addressed and treated, then a modifier-25 would be added to a E/M office visit 99212/99213...etc. etc.with the age appropiate wellness code too for seperate payment on each.
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Old 03-18-2011, 09:32 AM
dballard2004 dballard2004 is offline
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Thanks.
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Old 03-18-2011, 01:52 PM
Biller385 Biller385 is offline
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Check with your payers. Some may require the 25 for the E/M. A couple of years ago all payers were bundling the E/M with the vaccines unless the modifier was attached. Now some may not require it.

Cathy
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Old 03-21-2011, 05:56 AM
dballard2004 dballard2004 is offline
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Thanks so much Cathy!
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Old 03-25-2011, 05:35 PM
Bonnie Owen Bonnie Owen is offline
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I agree with this. This is how I bill.
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