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Vaccine and -25

  1. Default Vaccine and -25
    Medical Coding Books
    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

  2. #2
    Location
    Madison Area Chapter in Madison WI
    Posts
    113
    Default
    Quote Originally Posted by carmimcd View Post
    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.
    Happy Coding, Claudia


    Claudia Yoakum-Watson, CPC
    Coding, Compliance, & Reimbursement Solutions
    [email]ccrsconsulting@tds.net
    ccrsconsulting.com - website

  3. #3
    Default
    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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