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vaccine administration- Need help

  1. Question vaccine administration- Need help
    Medical Coding Books
    Hi Friends,

    Physician has administered three vaccinations to a patient.
    We have billed this as follows:
    Vaccine 1
    90471
    Vaccine 2
    90472
    Vaccine 3
    90472

    Insurance company has just paid for 90471 and 90472 and denied 90472 for third vaccine.
    How to bill for this service?
    How can we get paid for the third vaccination administration? Do we need to add any modifier to 90472?

    Thanks & Regards,
    Neha Bhatnagar CPC, CPC-H

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
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    Good morning - when you have multiple 90472 administrations, code 90472 x#. Otherwise, the insurance will look at the others as duplicates.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Default
    Ironically, I am holding on a call regarding this right now. Even if you bill 90471 x # the payors software may deny as a duplicate. You will learn over time to recognize these payors and it usually takes an adjustment request but you will be paid. Sorry there is not an easier solution but you will be paid.

  4. #4
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Correct coding would be to code:
    90471
    90472
    90472 59
    To start, the 90472 states, "each additional vaccine" and "list separately, next the CMS billing manual states that units of one unless the code is distributed as a quantity, and each is not a quantity, drugs come in quantities and timed services are a quantity of x minutes. So each additional vaccine must be separately listed with a 59 modifier. This is the correct and compliant way to code it, and the way to maximize your reimbursement.
    Debra Mitchell, MSPH, CPC-H

  5. #5
    Location
    Greeley, Colorado
    Posts
    2,045
    Default Respectfully Disagree
    Quote Originally Posted by mitchellde View Post
    Correct coding would be to code:
    90471
    90472
    90472 59
    To start, the 90472 states, "each additional vaccine" and "list separately, next the CMS billing manual states that units of one unless the code is distributed as a quantity, and each is not a quantity, drugs come in quantities and timed services are a quantity of x minutes. So each additional vaccine must be separately listed with a 59 modifier. This is the correct and compliant way to code it, and the way to maximize your reimbursement.
    Debra Mitchell, MSPH, CPC-H
    Debra - I have to respectfully disagree with this. When CPT states "each additional vaccine...list separately in addition to..." it means just that. Each vaccine and it's administration are separately billable and do not require modifier -59. With 90472 being an add-on code, modifier 59 is not necessary or applicable. 90472 must be coded x# if more than one additional administration is coded, otherwise any additional will be denied as duplicate. Also, since we are talking about administrations and not drugs/biologicals, quantities (x#) are appropriate.
    Lisa Bledsoe, CPC, CPMA

  6. #6
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    we code it exactly how Lisa describes to do so - always have - never have had an issue.
    I agree with Lisa - you do not use the .59 modifier on the 90472 - that would be incorrect. the initial admin is 90471 - and 90472 for any others (x's however many more they have) - in this case 90472x2.
    Donna, CPC, CPC-H

  7. #7
    Location
    St.Petersburg, Fl
    Posts
    46
    Default
    Yes I also agree with Lisa, I code for immunizations all the time and it is a x# never a modifier.
    Alecia Peck CPC

  8. #8
    Default
    Quote Originally Posted by lmjd View Post
    Ironically, I am holding on a call regarding this right now. Even if you bill 90471 x # the payors software may deny as a duplicate. You will learn over time to recognize these payors and it usually takes an adjustment request but you will be paid. Sorry there is not an easier solution but you will be paid.
    90471 x# would be denied as a duplicate because you can only administer one first vaccine.

    I agree with Lisa, we have always coded 90471 for the first vaccine and 90472 x # for each additional... in this case:

    90471
    90472 x 2
    Barbara Haskins CPC

  9. #9
    Default
    Yes! I was having a Senior Moment and they are getting more frequent!
    I meant to say 90472 x# not 90471- Shady Acres here I come!
    I also agree that it is incorrect to use a modifier on each additional administration.

  10. #10
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    I do realize that this is an old post, and I hate open a can of worms here, but I feel the need to chime in. CPT Assistant, November 2000 states that code 90472 is to be reported one time for each addtional vaccine administered. I agree that modifier 59 should also be used on each addtional 90472 code.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

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