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Wiki Vaccines/Well-Child Visit

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dballard2004

dballard2004

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The CPT guidelines state that if you have a significant, separately identifable E/M service in conjunction with vaccines, you report the E/M code with modifier 25. CPT gives an example in this case of either an office/outpatient E/M service or a preventative medicine service.

My question is this.....if a child presents for a well-child visit and we administer vaccines as part of the visit, do we report modifier 25 on the preventative E/M code? Are others doing this, or is this going to be payer specific? Thanks.
 
If the visit is specifically for Wellness...you should be using the proper E/M code for wellness, no modifier needed. Vaccines are billed with the appropiate administration codes w/ the vaccine (90471, 90472)...if the child has a seperate, identifiable illness...maybe a cough or runny nose, if addressed and treated, then a modifier-25 would be added to a E/M office visit 99212/99213...etc. etc.with the age appropiate wellness code too for seperate payment on each.
 
Check with your payers. Some may require the 25 for the E/M. A couple of years ago all payers were bundling the E/M with the vaccines unless the modifier was attached. Now some may not require it.

Cathy
 
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