Wiki Admin codes

[vickytia13]

Hello,

I am coding for a pediatrics office. I am receiving denials for 90471 and 90472, Era states that it is missing the admin code. From my understanding I thought the 90471 was an admin code. Most cases it is also billed with E/M service code. Any help would greatly be appreciated.

 

[mmborchardt]

Are you also billing for the vaccine? Secondly, is the vaccine through VFC?

 

[Cynthia Hughes]

Hello,

I am coding for a pediatrics office. I am receiving denials for 90471 and 90472, Era states that it is missing the admin code. From my understanding I thought the 90471 was an admin code. Most cases it is also billed with E/M service code. Any help would greatly be appreciated.

You might look at the bundling edits for codes submitted on the same claims. If your claims contain E/M services, including preventive E/M, modifier 25 is necessary to indicate the E/M service was beyond the counseling regarding the immunizations.

Also, are the physicians/QHPs not counseling the patients regarding the immunizations? If counseling is provided by a physician or QHP, codes 904960-90461 are recommended in addition to any E/M service with modifier 25 as appropriate.

I hope that helps.
Cindy