G0008 with 90471

mamon

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Originally, Medicare paid for the E/M, flu shot and admin (G0008), and denied the tetanus shot/admin (90471). We sent in an appeal for the tetanus, so Medicare paid for the tetanus shot/admin but then took back the payment for G0008 only, saying the denial is due to incorrect/missing modifier.

I've read that we should have used -59 on the 90471, but then I also saw a post saying that they did that and was still denied.

Has anybody come across the same situation? Any suggestions on exactly what modifiers and to which codes it should be attached?

ETA: I did find that Medicare requires -AT for the tetanus admin, but then they paid for it without that.

Thank you!
 
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ntreber

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90471 is for the first administration and would not be a valid code with G0008.
I would use CPT code 90472 for the second vaccine when billing Medicare with G0008, G0009, or G0010
 

mamon

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90471 is for the first administration and would not be a valid code with G0008.
I would use CPT code 90472 for the second vaccine when billing Medicare with G0008, G0009, or G0010
But G0008 is not the primary code for 90472, so I don't think it's appropriate to use. Could you link me to a source that could back that up, so I can have a reference? Thank you. :)

That aside, the information I'm specifically looking for would be the modifier to use, and on which to use it on; I'm thinking it should be 90471-59, but so far I have not found a definitive answer.
 

soccerdoc33

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But G0008 is not the primary code for 90472, so I don't think it's appropriate to use. Could you link me to a source that could back that up, so I can have a reference? Thank you. :)

That aside, the information I'm specifically looking for would be the modifier to use, and on which to use it on; I'm thinking it should be 90471-59, but so far I have not found a definitive answer.

QUESTION: I'm dealing with this right now and would love to avoid a denial. Was this ever resolved? If so can someone point me in the right direction please?

I'm trying to bill for: G0009, 90471 and 90472 x 2 and I don't know if I can add the 59 modifier or if I should slap a 25 modifier onto the 90471/90472 codes.

Thanks!!
 

ntreber

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I have always used 90472 Medicare vaccine administration codes. fist vaccine given G0008 - G0010 second vaccine given at same visit 90472 no denial. I do bill for an FQHC so that may make a difference but Medicare requires the "G" code making it the primary administration code.
 

danachock

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Trying to help with vaccine & admin woes

Say ... I may be able to help,
Alright I see numerous claim rejections 90715 billing to Medicare with admin (usually with other vaccinations). You need to determine what status indicator those vaccines each have. Medicare will not pay ... unless there is medical necessity. Those with a status indicator M we we bill out with modifier GY such as with 90715 along with GY modifier on the administration of vaccine code. I bill quite a bit of a mix for our facility. But nonetheless, we bill 90471 if it's the primary administration (depends on what vaccines were provided). Those G code vaccine administration codes being billed with 90471 would require a modifier 59 to be billed for separate reimbursement.
Thanks for listening,
Dana Chock, RHIT, CPC, CANPC, CHONC, CPMA, CPB
Professional Coding Analyst
 

bberube10

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I have always used 90472 Medicare vaccine administration codes. fist vaccine given G0008 - G0010 second vaccine given at same visit 90472 no denial. I do bill for an FQHC so that may make a difference but Medicare requires the "G" code making it the primary administration code.
90472 is not appropriate to use as the secondary administration unless 90471 is used. 90472 is an add on code for 90471 and 90460 ( if the second vaccine had no counseling)
 

mamon

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QUESTION: I'm dealing with this right now and would love to avoid a denial. Was this ever resolved? If so can someone point me in the right direction please?

I'm trying to bill for: G0009, 90471 and 90472 x 2 and I don't know if I can add the 59 modifier or if I should slap a 25 modifier onto the 90471/90472 codes.

Thanks!!
Our claim was resolved and Medicare paid. We did two things: first, we added modifier AT to both vaccine and admin codes (90715 and 90471); second, we sent out our office note to support/provide proof that the tdap was for an injury/wound.
 
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