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Need help with denial of well visits+flu shot

  1. Question Need help with denial of well visits+flu shot
    Medical Coding Books
    I do collections and recently found out that Bc/Bs have denied all well check up visits if performed on the same encounter with flu shot. However, if it's done with any other(s) vaccine(s), claim is processed and paid off. Could somebody explain me if this denial is correct and why? And if it's not correct is there any additional (besides CPT guidelines) info that can help me to appeal? I appreciate you response.
    Last edited by Oxana Petrenko; 04-18-2010 at 08:14 PM.

  2. #2
    Default
    did you use a 25 modifier

  3. Default
    Yes, we do use modifier 25, but in this case they deny administration of vaccine such as 90471

  4. #4
    Location
    Columbia, MO
    Posts
    12,527
    Default
    what dx are you linking to the 90471

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    Capital Coders, Columbia, SC
    Posts
    145
    Default
    Keep in mind that although very minor, immunization administrations and injections are procedures. You will need to protect your E/M with a 25.


    Bill Hale, CPC

  6. Smile
    Thanks everybody for your responses. We use v70.9/V20.2 for well check-ups and for flu shot and administration V04.81. Also, I got this issue fixed through provider representative. As appeared they have a system technical issue and now are working on this, so we should be fine shortly. I appreciate all of you for your help.

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