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90471 Denial

  1. #1
    Location
    Murfreesboro, TN
    Posts
    21
    Default 90471 Denial
    Medical Coding Books
    Is there a modifier that I need to add in order to get a 90471 paid in addition to a flu shot and a pneumovax? I got this denial on the admin code even though they paid the actual flu and pneumo codes.

    "This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated."

    Am I missing something?

    Thanks,
    Teresa M. Pearce, CPC

  2. Default
    Hello was this for a medicare claim?

  3. #3
    Location
    Murfreesboro, TN
    Posts
    21
    Default
    It was BlueCare.

  4. #4
    Default
    Quote Originally Posted by tmpearce View Post
    Is there a modifier that I need to add in order to get a 90471 paid in addition to a flu shot and a pneumovax? I got this denial on the admin code even though they paid the actual flu and pneumo codes.

    "This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated."

    Am I missing something?

    Thanks,
    Teresa M. Pearce, CPC

    Did they file on the same claim? Sounds like Blue is denying this because it didn't come across with the base (vaccine) code.

  5. #5
    Default
    Was this all that was billed the vaccine(s) and admin codes? If so, sounds like maybe you just need to make a call to the carrier to get the claim reprocessed.

    What are all the line items on this claim?
    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"

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