Wiki 90460 denials from McKesson edits

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lcoleman101

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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?
 
Same issue here. We are in the process of getting this resolved. This is obviously an issue in their system. The two claims I called on kept telling me something about G0008-G0010 needing to be billed as well because 90460 & 90461 were add on codes, which makes no sense. I argued that 90460 is not an add-on code but when you talking to a rep who is reading a script, its hard to get them to understand anything. I did go out to the clear claim editor on Cigna and run through the 90471 & 90472 (vaccine admin without counseling) and they worked fine and were all allowed but this is an issue in their system for 90460. You could demand the claims go back to Cigna's coders for claim review. This is an incorrect interpretation of AMA guidelines. I'll follow this thread if we find out the problem or when they correct it.
 
lgrant101 said:
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?
Click to expand...


Hi there,

Our practice is having the same exact issue. Definitely a Cigna system fail... but as far as I'm aware, they are the only company with this issue. We are reaching out to McKesson now to see how we can expedite this for resolution.

Sorry to hear that we aren't the only ones... Always something weird happening in the billing world :p
 
Cigna 90460-90461 denials

Update from Cigna:

From August 20, 2017 to August 31, 2017, an internal systems error occurred that resulted in the denial of vaccine administration CPT codes 90460 and 90461. Please note that this issue has been resolved, and any affected claims will be automatically reprocessed as soon as possible. No action is required by affected providers.
 
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