Results 1 to 4 of 4

Coding for THSTEPS- help!

  1. Default Coding for THSTEPS- help!
    Medical Coding Books
    I am having trouble getting paid for the 90471 and 90472 codes from Community First Medicaid. I am coding these with DX v20.2 and then following with the V codes for each vaccine that was administered. ex. v20.2, v06.1, v03.81 etc. I am getting paid by TMHP but not by Community First. I contacted the person who is the representative for the medicaid physicals for Community First but he tells me the reason they are not being paid is because I am following the v20.2 with these vaccine codes. That only the
    v20.2 should be listed. Also, he is telling me I should not be using the 25 modifier it should be used only for "acute care". I believe he is totally incorrect. When I showed him how TMHP is paying me he says that "this is their logic" on coding. I thought coding was a standard thing and not what one insurance makes up. Can someone give me some input? I have been coding for 3 years and have not encountered this.

  2. #2
    Default insurance
    Unfortunately, nothing is standard with insurance. I have found that each carrier decides what they want and will make you conform in order to get paid. Doesn't make it right, just is.

  3. Default
    Modifier 25 is not just for acute care though right? I am suppose to use it even for physicals?

  4. #4
    Default mod 25
    Again, that is payer specific. Some want the 25 on any E/M with another procedure no matter what the procedure is. Other's do not want the 25 on anything. Still other's do not want them on the preventive visits and some only with certain procedures. Sorry, I can't give you a definitive answer on this.

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.