Wiki Is mod 25 needed when billing a preventive visit and immunizations???

[dovejsd]

We are having a debate whether modifier 25 has to be added to the preventive visit when billing immunizations and immunization administration at the same visit. I need to know where I can find documentation supporting the answer. Thanks!

 

[Tamika118]

Flu Shots

I am having a problem getting paid for flu shots. We are billing 90658 & 90471 Can someone please help!! If you know where I can find the answer please let me know.

 

[RebeccaWoodward*]

Is there a particular carrier?

Medicare requires 90658 and G0008 with V04.81

http://www.aafp.org/fpm/20071000/35codi.html

 

[rthames052006]

We are having a debate whether modifier 25 has to be added to the preventive visit when billing immunizations and immunization administration at the same visit. I need to know where I can find documentation supporting the answer. Thanks!

What insurance (s) are you having issues with? From my experience we have only had this issue with Aetna who requires the 25 modifier. The majority of other insurances I deal with don't require a 25 when billing a preventative visit and immunizations.

 

[Chanda]

Thanks, I needed the answer to the same question also.

 

[maysons1703]

Isn't the flu shot apart of the preventative visit? Why would a -25, be necessary? Would you code a modifier for a collection of a pap?

 

[rthames052006]

Isn't the flu shot apart of the preventative visit? Why would a -25, be necessary? Would you code a modifier for a collection of a pap?

Not necessarily, like I said previously certain carriers will require a 25 modifier that is carrier specific. I haven't run into any scenerio where I needed to add a modifier to a pap collection.