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E/M with an immunization

  1. #1
    Default E/M with an immunization
    Medical Coding Books
    I am having issues with Blue Cross paying an office visit when a patient receives an immunization on the same day as an unrelated E/M visit. I have no issues with any other insurances getting both paid but Blue Cross pays the lesser of the two which tends to be the injection. Is anyone else having this issue I don't see how a modifier 25 should be used in the scenario since these are immunizations.

  2. #2
    Location
    Milwaukee, WI
    Posts
    61
    Default CCI Edits
    There is a CCI edit mandating the use of a 25 modifier if there is an E&M code billed on the same date as an immunization code. If there is no modifier appended, you will likely not receive payment for both from any payer that has implemented the CCI edits.

  3. #3
    Default
    We did actually bill some claims initiailly with a modifier 25 and still received denial on the E/M immunization was still paid. Is this CCI edit going to involve more insurances?

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