Wiki Modifier 22 for Vaccines

[celip]

Hello,
I had a rep from BCBS of Rhode Island asking me to edit an invoice for a patient to include modifier 22 on a typhoid vaccine that was given for traveling purposes. I let the rep know that this modifier represents increased procedural services and should really only be used when coding for surgery procedures. She stated that this is what BCBS of RI uses to represent that the vaccine was not state supplied, which does not make any sense to me. I looked into state guidelines and even reached out to state immunization board reps who had no insight regarding this. Am I correct in thinking that this modifier would not be appropriate to use for a vaccine?

 

[thomas7331]

I agree with you, and I would never use a verbal statement from a payer rep to make any coding decisions. They are usually not coders, and even if they are, they have not reviewed your medical records and have no business tell you what you should or should not code. If that in fact is their policy that this is how they want travel vaccines coded, then they need to show you where it is in writing so that you can have documentation to support what you are putting on their claim.

 

[iowagirl77]

Hello,
I had a rep from BCBS of Rhode Island asking me to edit an invoice for a patient to include modifier 22 on a typhoid vaccine that was given for traveling purposes. I let the rep know that this modifier represents increased procedural services and should really only be used when coding for surgery procedures. She stated that this is what BCBS of RI uses to represent that the vaccine was not state supplied, which does not make any sense to me. I looked into state guidelines and even reached out to state immunization board reps who had no insight regarding this. Am I correct in thinking that this modifier would not be appropriate to use for a vaccine?

It does appear to be what they want, although it does seem odd. See the details on pages 8-9. https://www.bcbsri.com/providers/si...3 Coding and Payment Guidelines Modifiers.pdf

 

[celip]

It does appear to be what they want, although it does seem odd. See the details on pages 8-9. https://www.bcbsri.com/providers/sites/providers/files/policies/2023/02/2023 Coding and Payment Guidelines Modifiers.pdf

Thank you for this! From my knowledge modifier 22 requires the proper documentation from the provider in order to support the use of the modifier. In our case since it's a vaccine we don't have the appropriate documentation, which is why I was hesitant to add the modifier. Would you say that these guidelines could suffice as documentation?