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NCCI Edits and Vaccines

  1. #1
    Overland Park, KS
    Default NCCI Edits and Vaccines
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    Can someone please explain the NCCI edits regarding Medicare and vaccines? I know that you report the G codes for the administration of the flu, pneumonia, and Hepatitis B vaccines, but I notice an NCCI edit for 90471 and the G codes and 90472 and the G codes.

    The mutually exclusive edits show 90471 listed twice as being bundled in G0008, G0009, and G0010. One edits shows they can be bypassed with a modifier (1) and the other edits hows they can't be bypassed at all (0). Can someone please interpt this please? Can you report these together or not?

    Can someone provide me with an example of when you would use 90471 in conjunction with G0008, please?

    Also, the mutually exclusive edits show 90472 bundled into the G codes with a "0" indicating you can't bypass the edits. So how do you report additional vaccines? Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  2. #2
    Overland Park, KS
    Also, 99211 appears on the NCCI edits as bundled with the vaccine codes with an indicator of "0." So what happens if the patient presents for the vaccine, sees the nurse only, and the nurse provides a significant, separately identifable E/M in addition to the vaccine? If 99211-25 is prohibited, then what? They have to see the provider?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  3. #3
    Overland Park, KS
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  4. #4
    g0008 and g0009 are admin codes for flu and pneumonia for Medicare patients. you can code w/ E & M code if given by nurse - not doctor -with a 25 modifer. 90471 and 90472 are admin codes for non- medicare patients. When pt comes in for vaccines & sees nurse only you bill admin code and vaccine codes 90658 & 90732. both admin & vaccine codes are reported together for flu and pneumonia. Is this what you were referring to?

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