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Can someone please clarify 90472

  1. #11
    Greeley, Colorado
    Medical Coding Books
    Quote Originally Posted by mitchellde View Post
    we may just have to disagree, the 1500 has its own billing manual that has been continuously updated thru the years. Many times you may have read the statement but it is subtle and many people miss it. However I discovered it when we continued to be under paid and or denied when this was done, I did a ton of research and finally deciphered the statement. They use the language of quantity distribution and then do not clarify what this is referring to. I am sorry that you disagree but I maintain the 59 modifier is correct regardless of which method you wish to use. I know several will continue to use units. So we will just have to let it go at that.
    Agreed. We will just agree to disagree.
    Lisa Bledsoe, CPC, CPMA

  2. #12
    Overland Park, KS
    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

  3. Default
    I agree with the last poster. I am sitting here with a denial stating that the AMA defines CPT code 90472 as "...list separately in addition to code for primary procedure". They go on to state that "According to the MUE's, this code may be billed no more than 4 units per day for the same beneficiary." We billed 6 immunizations with 6 diagnoses and 90471 with 90472 X 5. Does anyone have a suggestion and I am not good at settling with the fact that we cannot bill the patient or we cannot expect to get paid for a service we performed and does anyone have a link to the MEU that states only 4 units per day allowed for the same beneficiary??

  4. Default
    We've never billed more than 3 units of 90472 so I'm not sure what to suggest. MUEs are in place to help reduce claim errors. Since your claim is not in error, see if you can appeal with medical necessity.

    The MUE is found here: CMS MUE LINK

    It does list 4 units for 90472.

  5. Default
    Thank you so much for your help, this finally paid.

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