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vaccine admin- Need help

  1. Default vaccine admin- 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. Default
    This seems to be a payor specific issue. The best way to address it is to see why the payor denied payment (are there reason codes or an explanation for the denial?) for the 2nd 90472. Perhaps their policy is 2 vaccine administrations per day (visit) or maybe they suspect that 2 of the vaccines were a combo vax and therefore only agree to pay the single injection. The possibilities can vary; only the payor can explain or give rational as to why they denied payment. Once they give you the reason for the denial then you can explore as to whether or not they will pay if a modifier were appended and the rational behind appending the modifier.

    Hope this helps,
    Anthony McCallum, CPC, CIRCC, CPC-I, CCS
    ciphermed@optonline.net

  3. #3
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by neha.bhatnagar View Post
    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
    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

  4. Thumbs up
    Thanks for the help.

    Regards,
    Neha Bhatnagar, CPC, CPC-H

  5. Default
    Add modifier 76 to the 3rd vaccine administration

  6. #6
    Location
    Columbia, MO
    Posts
    12,531
    Default
    Not a 76 add a 59, it was not a repeat service it was another distinct and separate injection, it needs a 59. I know I have said this many times in this forum and you will hear it from me every time.. do not bill with units. Use a new line to report unique and separate procedures. The book state with the 90472, each additional vaccine, list separately..... They did not pay the third one because without a modifier it appears as a duplicate line item.

  7. #7
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Default
    It appears that these admin. codes are processed differently by different carriers in different regions. (I'm in SC) I, also, have been billing 90471 + 90472 + 90472-59. However, any additional 90427-59's are denied as dup. I have been looking for a solution. The suggestion made by Lisa Curtis on this and another recent thread re billing 90472 as multiple units has sparked my curiosity. I will test this on a couple of claims to commercial carriers. Has anyone else tested this and had unsuccessful results?

  8. #8
    Default
    We (in MN) do as Lisa says - bill 90472 with # of additional vaccines. We haven't had problems with that.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  9. #9
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by halebill View Post
    It appears that these admin. codes are processed differently by different carriers in different regions. (I'm in SC) I, also, have been billing 90471 + 90472 + 90472-59. However, any additional 90427-59's are denied as dup. I have been looking for a solution. The suggestion made by Lisa Curtis on this and another recent thread re billing 90472 as multiple units has sparked my curiosity. I will test this on a couple of claims to commercial carriers. Has anyone else tested this and had unsuccessful results?
    Let me know how it turns out. We do not have problems with units here in Colorado.
    Lisa Bledsoe, CPC, CPMA

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