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Is mod 25 needed when billing a preventive visit and immunizations???

  1. #1
    Red face Is mod 25 needed when billing a preventive visit and immunizations???
    Medical Coding Books
    We are having a debate whether modifier 25 has to be added to the preventive visit when billing immunizations and immunization administration at the same visit. I need to know where I can find documentation supporting the answer. Thanks!

  2. #2
    Default Flu Shots
    I am having a problem getting paid for flu shots. We are billing 90658 & 90471 Can someone please help!! If you know where I can find the answer please let me know.

  3. #3
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    North Carolina
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    Default
    Is there a particular carrier?

    Medicare requires 90658 and G0008 with V04.81

    http://www.aafp.org/fpm/20071000/35codi.html

  4. #4
    Default
    Quote Originally Posted by dovejsd View Post
    We are having a debate whether modifier 25 has to be added to the preventive visit when billing immunizations and immunization administration at the same visit. I need to know where I can find documentation supporting the answer. Thanks!
    What insurance (s) are you having issues with? From my experience we have only had this issue with Aetna who requires the 25 modifier. The majority of other insurances I deal with don't require a 25 when billing a preventative visit and immunizations.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  5. Default
    Thanks, I needed the answer to the same question also.
    C.A., CPC

  6. #6
    Default
    Isn't the flu shot apart of the preventative visit? Why would a -25, be necessary? Would you code a modifier for a collection of a pap?

  7. #7
    Default
    Quote Originally Posted by maysons1703 View Post
    Isn't the flu shot apart of the preventative visit? Why would a -25, be necessary? Would you code a modifier for a collection of a pap?
    Not necessarily, like I said previously certain carriers will require a 25 modifier that is carrier specific. I haven't run into any scenerio where I needed to add a modifier to a pap collection.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

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