Vaccine and -25

carmimcd

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Hi Everyone,

I am new to the forum and this would be my first posting.

I was just told yesterday that modifier 25 is not needed on the E/M line when giving the influenza vaccine (any immunization) on the same day as a medical visit.

We have always used modifier 25. I called WPS today and the person I spoke with also said no modifier was needed but she was not able to refer me to documentation other than the CCI edits.

Example: 99213 -25 401.1
90658 V04.81
G0008 V04.81

Carmela McDermott
McLaren Internists
 
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114
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Madison Area Chapter in Madison WI
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Hi Everyone,

I am new to the forum and this would be my first posting.

I was just told yesterday that modifier 25 is not needed on the E/M line when giving the influenza vaccine (any immunization) on the same day as a medical visit.

We have always used modifier 25. I called WPS today and the person I spoke with also said no modifier was needed but she was not able to refer me to documentation other than the CCI edits.

Example: 99213 -25 401.1
90658 V04.81
G0008 V04.81



Carmela McDermott
McLaren Internists
Carmela, welcome to the Forum. This is a great place to get information from some VERY knowledgeable E/M coders. Although I am not an E/M guru,
I believe from a coding perspective the 25 is appropriate if a significant separate E/M was performed with the flu shot. If I think of this a little more, I come to the conclusion that regardless of what the payer may want, it doesn't hurt to append it. I'm interested to see what others have to say.
 

maysons1703

Networker
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Temple
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If the flu vaccine was administered during a preventative service, I would say no. If the patient presents for asthma f/up and the provider decides to give the patient a flu shot, then it would be appropriate to append a modifier -25 to the E/M visit.
Melissa Freeman, CPC
 
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