I am having trouble getting paid for the 90471 and 90472 codes from Community First Medicaid. I am coding these with DX v20.2 and then following with the V codes for each vaccine that was administered. ex. v20.2, v06.1, v03.81 etc. I am getting paid by TMHP but not by Community First. I contacted the person who is the representative for the medicaid physicals for Community First but he tells me the reason they are not being paid is because I am following the v20.2 with these vaccine codes. That only the
v20.2 should be listed. Also, he is telling me I should not be using the 25 modifier it should be used only for "acute care". I believe he is totally incorrect. When I showed him how TMHP is paying me he says that "this is their logic" on coding. I thought coding was a standard thing and not what one insurance makes up. Can someone give me some input? I have been coding for 3 years and have not encountered this.
v20.2 should be listed. Also, he is telling me I should not be using the 25 modifier it should be used only for "acute care". I believe he is totally incorrect. When I showed him how TMHP is paying me he says that "this is their logic" on coding. I thought coding was a standard thing and not what one insurance makes up. Can someone give me some input? I have been coding for 3 years and have not encountered this.