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Modifier 59 for Vaccines

  1. #1
    Location
    Overland Park, KS
    Posts
    1,166
    Default Modifier 59 for Vaccines
    Medical Coding Books
    If a Medicare patient presents for the influenza vaccine and the rabies vaccine in the same encounter (may not be logical, but let's say it happened for the sake of this example), how would you report this?

    Would you report:

    90658
    G0008
    90675
    90471 -59

    or 90658
    G0008
    90675
    90472 -59

    Is modifier 59 needed (NCCI editis are conflicting) and can you use 90472 with the G code without 90471 (again NCCI editis are confusing here. They show 90472 and G0008 as being bundled on the mutually exclusive edits?)?

    Thoughts?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. #2
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Any ideas?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  3. #3
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Anyone?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Default
    Somewhere on the forum someone posted a similar question regarding multiple vaccines. If I remember correctly, the person who responded stated that since G0008 is used for the "first" vaccine, then you would use 90472 to indicate the "second". I don't recall that anything was stated about the addition of a modifier. So given that, I would report

    90658
    G0008
    90675
    90472

    I have tried searching the forums to find the previous post without success.


    I hope this information is helpful to you.
    Teresa Collins, CPC

  5. #5
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  6. #6
    Default G0008 and G0402
    Is a modifier needed if G0008 and G0402 are billed together? I got a denial.

    thanks!
    Dena Brandt CPC

  7. #7
    Default
    No, a modifier shouldn't be needed. What was the denial? Also what ICD-9 codes were used?
    Teresa Collins, CPC

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