Wiki Need help with 90741

[lataashwini23@gmail.com]

i work for urgent care billed as below
12002
90471
90715
DX code
S51.012A
Z23

Medicare denied code 90471- PR 96,M16, N431.
90715 - PR49, M429.

I have not use the modifier what would be the correct modifier to use and for what code?

 

[jhendrix08]

I would add modifier 59 to the admin of the vaccine (90471).

 

[katemae84]

There is no NCCI edit between the procedure codes, so you shouldn't need a modifier, I would think the problem is the diagnosis code. Medicare does not cover Tdap immunizations that they consider "routine" and won't pay for it if it's not submitted with an injury diagnosis code. Try resubmitting the 90471 & 90715 linked to the S51.012A diagnosis instead of Z23.

 

[jhendrix08]

Katemae is right...I overlooked that it's a Medicare patient. Definitely worth trying to resubmit with the S code linked to 90471 rather than the Z code.

 

[mamon]

The above is correct, Medicare won't pay for 90715 unless it's for an injury. What we did is we used modifier AT on 90471 and 90715 and submitted our office notes to support our claim that it was for an injury/wound. Link below

Tetanus Vaccine

 

[vanessamoldovan]

i work for urgent care billed as below
12002
90471
90715
DX code
S51.012A
Z23

Medicare denied code 90471- PR 96,M16, N431.
90715 - PR49, M429.

I have not use the modifier what would be the correct modifier to use and for what code?

Please note the information in the link below that indicates the approved Medicare codes for immunization. https://www.cms.gov/Outreach-and-Ed...k-MLN/MLNProducts/Downloads/qr_immun_bill.pdf

vanessa.moldovan@aapcnab.com

 

[lataashwini23@gmail.com]

Thank you

 

[dxanthos]

I bill for Urgent Care as well. For injuries I bill for:
1) Office visit with modifier 25
2) Suturing (if applicable)
3) vaccine with modifier AT - Dx should be the injury code NOT Z23
4) administration of vaccine with modifier 25 and AT - Dx code should be the injury code NOT Z23

I do not use Dx Z23 as a pointer for any of the procedures. No issues being paid by Medicare. You must have the AT modifier and injury code.