Results 1 to 10 of 10

Vaccinations--Please help!!

  1. #1
    Default Vaccinations--Please help!!
    Medical Coding Books
    I'm having some trouble getting vaccination administration codes paid for adults... We're billing G0008 (admin of flu vaccine), 90471-polio, 90472-Tetanus & diptheria. I believed CMS recognized the G code as an initial code so originally we billed the G code and only 90472s for the remaider of the drugs. We changed that and now we are billing as stated above. We are getting denials now because the 90471 and the G code are bundled. I chaecked CCI and they are bundled. WPS (our carrier) is telling us we need a 59 on the G code... I was under the impression that we don't use modifiers on HCPCS codes?? Anybody had any luck getting these code sets paid when having to bill with the G code for either flu or pneumoccoccal vaccines? Thank you!!

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Are you billing 90471 and 90472 with E/M's? They are not billable on the same day as an E/M.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Default
    No E&M... Here's the way it looks, for example...
    G0009
    90732
    90472
    90718
    90472
    90713
    90472
    90648

    I've tried billing a 90471 with a G0009, but that didn't work; that's when the bundling denial came about. The 90472 will not pay w/o billing a 90471. The 90471 will not pay w/ the G0009... I have also tried billing the 90472s in units, but that didn't work either. Thanks!

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    90718, 90713 and 90648 are not covered by Medicare, so the administration codes would also not be covered.
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Default
    Be sure to have your patients sign an ABN before receiving these non-covered items, and bill them to Medicare with modifier GA appended. Then you will be able to bill the patient.

  6. #6
    Default
    Some of these vaccines are covered by Medicare after bone marrow and or stem cell transplants...

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    In that case, I would contact your MAC/FI and see what the problem is. Sometimes they can be very helpful... Good luck!
    Lisa Bledsoe, CPC, CPMA

  8. Default
    I am also having issues with Medicare denying the Admin G codes with 90472's =. regardless of the Medication. The fact is that they are bundling the G codes with the additional Vaccination admins.

  9. #9
    Default
    Quote Originally Posted by Lisa Curtis View Post
    Are you billing 90471 and 90472 with E/M's? They are not billable on the same day as an E/M.
    Hi Lisa, Can't you bill both with a -25 on the E/M. We have been doing that in our ER visits for some time now. Is this not correct? We are also critical access if that matters. Thanks

  10. #10
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Leslie - could be different for critical access. I know in the office setting Medicare will not pay 90471-90472 even when a covered vaccine is given at the time of an E/M. The exception is G0008 and G0009.
    Lisa Bledsoe, CPC, CPMA

Similar Threads

  1. Vaccinations
    By nkawtgn in forum Family Practice
    Replies: 1
    Last Post: 09-20-2015, 10:44 AM
  2. vaccinations - cpt code
    By grams1 in forum Pediatrics
    Replies: 1
    Last Post: 10-02-2009, 08:13 AM
  3. vaccinations
    By pskinner in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 01-01-2009, 03:23 AM
  4. vaccinations
    By dawn1170 in forum Internal Medicine
    Replies: 6
    Last Post: 03-24-2008, 01:48 PM
  5. Vaccinations
    By dawn1170 in forum Family Practice
    Replies: 5
    Last Post: 03-13-2008, 08:36 AM

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?

Login

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.