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flu vaccine

safnlp

Contributor
Messages
23
Best answers
0
If you bill a EM and flu vaccine and the administration together do you have to use mod 25 on the ov Someone says yes and someone else said no this is when the dr sees the pt I am not talking about just a 99211
 

motherbyrd

Contributor
Messages
13
Location
Pinebluff, NC
Best answers
0
My experience has been that yes you do need to append the 25 modifier to the office visit.
Medicaid will pay the claim from the bottom up and will pay either the office visit or the administration, whichever it reaches first. It will not pay both.
Blue Cross has been requiring the 25 modifier with both 90772 and 90471 according to my payment posters.
 

S Avara CPC

Guest
Messages
41
Location
Baton Rouge Local Chapter
Best answers
0
Yes, it is best to use a modifier 25 to show the E/M is seperate from the administration of the flu vaccine. If you do not some carriers will pay the administration and deny the office visit. There may be a couple that do not require it but it will not hurt to add it, it's better to be safe then sorry.
 

bhaskins1

Networker
Messages
92
Best answers
0
We don't use the modifier because the e/m code has it's own diagnosis attached to it. We have not had any problems with NC Medicaid or any other carrier with this. I'm in pediatrics and this happens year round with our practice... not just with flu vaccines... often a child is in the office for a problem visit and in reviewing the chart the doctor will determine it is time to update or give a booster of a vaccine while the child is here.

Hope this helps.
 

dmaec

True Blue
Messages
1,133
Location
Hibbing, Minnesota
Best answers
0
we always modify the E/M when immunizations are given. Documentation supporting E/M and immunizations or course! We link the dx's accordingly. We do this for ALL insurances.
 
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