e/m charge with immunizations diag

kimb

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if someone came in for a tdap (v06.1) and to see the physician would you link that to the e/m 99213

ex: 99213
90471
90715

401.9, v06.1

99213 diag 1 & 2
990471 diag 2
90715 Diag 2
 

dmaec

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I'd link dx 1 -401.9 to the office visit with a .25 modifier
99213.25
and dx 2 - V06.1 to the 90715 & 90471 only, NOT to the office visit

:)
 

rthames052006

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if someone came in for a tdap (v06.1) and to see the physician would you link that to the e/m 99213

ex: 99213
90471
90715

401.9, v06.1

99213 diag 1 & 2
990471 diag 2
90715 Diag 2
I wouldn't link dx #2 to the e/m, I'd use that for the tdap and admin only. With modifier 25 on the visit.
 

LOVE2CODE

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if someone came in for a tdap (v06.1) and to see the physician would you link that to the e/m 99213

ex: 99213
90471
90715

401.9, v06.1

99213 diag 1 & 2
990471 diag 2
90715 Diag 2

Where is the V05.9 (admin dx code)????????

I would code as:

1) 401.9
2) V06.1
3) V05.9

99213-25 Dx 1,2
90715 Dx 2
90471 Dx 3


Hope this helps....

YTH, CPC
 

dmaec

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YTHASKINS - why would you use the V05.9? it doesn't look like an adim code to anything - it appears to me, to be a very vague dx for some unspecified disease. They don't have a disease, they're getting a immunization-the admin code "is" the 90471 and is linked to the immunization code (V06.1 in this case) - accordingly if more than one vaccine given then 90472 x's however many and linked to the vaccine V-code. :)
 

Kris Cuddy

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Agreed, V05.9 is unnecessary. Just wondering why modifier 25 would be needed on the E/M with this? It's definitely needed if billing 90772 with an E/M, but most carriers recognize 90471 as a completely separate service. Since modifier 25 usage is always under scrutiny, perhaps bill some to your carriers without it when an immunization is given and if they don't reject you'll know it's no longer needed.

99213 - 401.9
90715 - V06.1
90471 - V06.1

Kris
 

LOVE2CODE

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YTHASKINS - why would you use the V05.9? it doesn't look like an adim code to anything - it appears to me, to be a very vague dx for some unspecified disease. They don't have a disease, they're getting a immunization-the admin code "is" the 90471 and is linked to the immunization code (V06.1 in this case) - accordingly if more than one vaccine given then 90472 x's however many and linked to the vaccine V-code. :)

Oops.....You are absolutely correct....I stand to be corrected....

YTH, CPC
 

rthames052006

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Agreed, V05.9 is unnecessary. Just wondering why modifier 25 would be needed on the E/M with this? It's definitely needed if billing 90772 with an E/M, but most carriers recognize 90471 as a completely separate service. Since modifier 25 usage is always under scrutiny, perhaps bill some to your carriers without it when an immunization is given and if they don't reject you'll know it's no longer needed.

99213 - 401.9
90715 - V06.1
90471 - V06.1

Kris
Kris,

In my neck of the woods and the carriers we deal with we have to use the 25 modifier for 90471 and 90772 or else it doesn't get paid, it would be nice to not have to use it but....

I do agree with you on the cpt and dx you have listed for the procedures.
 

LOVE2CODE

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Kris,

In my neck of the woods and the carriers we deal with we have to use the 25 modifier for 90471 and 90772 or else it doesn't get paid, it would be nice to not have to use it but....

I do agree with you on the cpt and dx you have listed for the procedures.



We have to use the modifier also for most of our carriers....

YTH, CPC
 
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