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Thread: visit with injection denied

  1. #1
    Join Date
    Apr 2007
    Melbourne, Florida

    Default visit with injection denied

    AAPC: Back to School
    any suggestions on how to receive payment from Medicare when we bill for an administration of an injection (90471) , but not for the product (zoster for shingles) .. I believe the 99211 will be denied ..and we cannot bill it with a modifier 25. (the 90471 alone is denied since it is not accomanied with the zoster, since the patiend supplied it, we didn't bill for it..... once again.. any help is appreciated.
    Denise Gilrane-Pillow, CPB

  2. #2
    Join Date
    Apr 2007
    Johnson City


    I have a question:

    Did you have the patient purchase the drug, and bring to appointment? I was just wondering because we have been tracking our reimbursement on our injectable drugs. We lose alot of money on the drug code reimbursements. I was curious to know if this is common with other practices. Or are we missing the boat somewhere?

    Melissa Jewett, CPC

  3. #3
    Join Date
    Apr 2007
    Sioux Falls South Dakota


    Will your practice management (billing) software let you put in the code for the zoster vaccine with a zero or 1 cent charge? That is what we do with state-supplied vaccines, so the insurance knows which vaccine we are injecting.

    Hope this helps!
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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