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mcurtis739

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I am trying to bill for the following:

99214
1033F
3008F
90472

When I try, I get the following message.

Code 99214 is a component of code 96372 but a modifier is allowed on 99214.
Code 99214 is a component of code 90472 but a modifier is allowed on 99214.
The Procedure Code (90472) is defined as an add-on code.
The Procedure Code (90472) is invalid or requires a parent that is not on the claim.

The patient is 78 so I'm not sure what the 4th line means.

Can someone please tell me how to resolve this? Again I am new and will be starting my training with AAPC November 2018.

Thank you for any help you can give.
 
Looks to me you are trying to bill several different codes here. Let's break each down:

*99214 - Regular office E/M visit, level 4. Moderate complexity.
*96372 - Therapeutic injection. You should specify the drug used here somewhere on the claim. Probably the Immunization?
*90472 - Immunization Administration.
*3008F - BMI documented - a Category II reporting code. No direct RVU associated.
*1033F - Current tobacco non-smoker (asthma) - another Category II reporting code with no direct RVU.


All these codes could work (assuming medical necessity was properly documented), if you append Modifier 25 to 99214.

Hope that helps and good luck in your upcoming AAPC training!
 
Thank you! That really helped. When I append the 25, I get the following:

The procedure code (90472) is defined as an add-on code.
The procedure code (90472) is invalid or requires a parent that is not on the claim.

What do you recommend for resolving this? The patient is in her 80s.

Thanks again!



Pathos said:
Looks to me you are trying to bill several different codes here. Let's break each down:

*99214 - Regular office E/M visit, level 4. Moderate complexity.
*96372 - Therapeutic injection. You should specify the drug used here somewhere on the claim. Probably the Immunization?
*90472 - Immunization Administration.
*3008F - BMI documented - a Category II reporting code. No direct RVU associated.
*1033F - Current tobacco non-smoker (asthma) - another Category II reporting code with no direct RVU.


All these codes could work (assuming medical necessity was properly documented), if you append Modifier 25 to 99214.

Hope that helps and good luck in your upcoming AAPC training!
Click to expand...
 
I suppose I made it evident that I don't audit many injections :)

90472 is an add on code, which means it applies to a parent code. This means in order to bill this code, there must be another code which has a certain range of amount used (can be 1). For example, 90472 specifies "each additional vaccine", meaning on top of the parent code vaccine. You would need a parent code depending on what is being injected, route of medication and the amount of vaccine.

Here is a link to an AAPC forum post on the subject of 90472.

Hope this helps more!
 
90472 is an add on code since its for a second injection. You need the primary injection code. According to my encoder the primary injection codes allowed are (90460, 90471, 90473, G0008, G0009, G0010).
Also note these injection codes also edit to an E&M code. So if the E&M is significant and separately identifiable from the vaccine, modifier 25 is required on the E&M. Basically you are attesting that you are not one of the unscrupulous providers that are billing E&M when the sole purpose of visit is to receive an immunization.
 
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