Wiki Need help with denial of well visits+flu shot

[Oxana Petrenko]

I do collections and recently found out that Bc/Bs have denied all well check up visits if performed on the same encounter with flu shot. However, if it's done with any other(s) vaccine(s), claim is processed and paid off. Could somebody explain me if this denial is correct and why? And if it's not correct is there any additional (besides CPT guidelines) info that can help me to appeal? I appreciate you response.

 

[kbarbag]

did you use a 25 modifier

 

[Oxana Petrenko]

Yes, we do use modifier 25, but in this case they deny administration of vaccine such as 90471

 

[mitchellde]

what dx are you linking to the 90471

 

[halebill]

Keep in mind that although very minor, immunization administrations and injections are procedures. You will need to protect your E/M with a 25.


Bill Hale, CPC

 

[Oxana Petrenko]

Thanks everybody for your responses. We use v70.9/V20.2 for well check-ups and for flu shot and administration V04.81. Also, I got this issue fixed through provider representative. As appeared they have a system technical issue and now are working on this, so we should be fine shortly. I appreciate all of you for your help.