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e/m charge with immunizations diag

  1. #1
    Question e/m charge with immunizations diag
    Exam Training Packages
    if someone came in for a tdap (v06.1) and to see the physician would you link that to the e/m 99213

    ex: 99213
    90471
    90715

    401.9, v06.1

    99213 diag 1 & 2
    990471 diag 2
    90715 Diag 2

  2. #2
    Default
    1)401.9, 2)v06.1
    99213-25 1) & 2)
    90471 2)
    90715 2)

    Quote Originally Posted by kimb View Post
    if someone came in for a tdap (v06.1) and to see the physician would you link that to the e/m 99213

    ex: 99213
    90471
    90715

    401.9, v06.1

    99213 diag 1 & 2
    990471 diag 2
    90715 Diag 2
    Last edited by racheleporter; 06-23-2008 at 03:02 PM. Reason: pointer
    Rachele Porter, AS, CPC, CPC-H, CEDC
    no weapons formed against me shall prosper

  3. #3
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    I'd link dx 1 -401.9 to the office visit with a .25 modifier
    99213.25
    and dx 2 - V06.1 to the 90715 & 90471 only, NOT to the office visit


  4. #4
    Default
    Quote Originally Posted by kimb View Post
    if someone came in for a tdap (v06.1) and to see the physician would you link that to the e/m 99213

    ex: 99213
    90471
    90715

    401.9, v06.1

    99213 diag 1 & 2
    990471 diag 2
    90715 Diag 2
    I wouldn't link dx #2 to the e/m, I'd use that for the tdap and admin only. With modifier 25 on the visit.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  5. #5
    Smile
    Quote Originally Posted by kimb View Post
    if someone came in for a tdap (v06.1) and to see the physician would you link that to the e/m 99213

    ex: 99213
    90471
    90715

    401.9, v06.1

    99213 diag 1 & 2
    990471 diag 2
    90715 Diag 2

    Where is the V05.9 (admin dx code)????????

    I would code as:

    1) 401.9
    2) V06.1
    3) V05.9

    99213-25 Dx 1,2
    90715 Dx 2
    90471 Dx 3


    Hope this helps....

    YTH, CPC

  6. #6
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    YTHASKINS - why would you use the V05.9? it doesn't look like an adim code to anything - it appears to me, to be a very vague dx for some unspecified disease. They don't have a disease, they're getting a immunization-the admin code "is" the 90471 and is linked to the immunization code (V06.1 in this case) - accordingly if more than one vaccine given then 90472 x's however many and linked to the vaccine V-code.

  7. Default
    Agreed, V05.9 is unnecessary. Just wondering why modifier 25 would be needed on the E/M with this? It's definitely needed if billing 90772 with an E/M, but most carriers recognize 90471 as a completely separate service. Since modifier 25 usage is always under scrutiny, perhaps bill some to your carriers without it when an immunization is given and if they don't reject you'll know it's no longer needed.

    99213 - 401.9
    90715 - V06.1
    90471 - V06.1

    Kris

  8. #8
    Smile
    Quote Originally Posted by dmaec View Post
    YTHASKINS - why would you use the V05.9? it doesn't look like an adim code to anything - it appears to me, to be a very vague dx for some unspecified disease. They don't have a disease, they're getting a immunization-the admin code "is" the 90471 and is linked to the immunization code (V06.1 in this case) - accordingly if more than one vaccine given then 90472 x's however many and linked to the vaccine V-code.

    Oops.....You are absolutely correct....I stand to be corrected....

    YTH, CPC

  9. #9
    Default
    Quote Originally Posted by kforkismet View Post
    Agreed, V05.9 is unnecessary. Just wondering why modifier 25 would be needed on the E/M with this? It's definitely needed if billing 90772 with an E/M, but most carriers recognize 90471 as a completely separate service. Since modifier 25 usage is always under scrutiny, perhaps bill some to your carriers without it when an immunization is given and if they don't reject you'll know it's no longer needed.

    99213 - 401.9
    90715 - V06.1
    90471 - V06.1

    Kris
    Kris,

    In my neck of the woods and the carriers we deal with we have to use the 25 modifier for 90471 and 90772 or else it doesn't get paid, it would be nice to not have to use it but....

    I do agree with you on the cpt and dx you have listed for the procedures.
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  10. #10
    Smile
    Quote Originally Posted by rthames052006 View Post
    Kris,

    In my neck of the woods and the carriers we deal with we have to use the 25 modifier for 90471 and 90772 or else it doesn't get paid, it would be nice to not have to use it but....

    I do agree with you on the cpt and dx you have listed for the procedures.



    We have to use the modifier also for most of our carriers....

    YTH, CPC

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