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Modifier Quandry for Medicare

  1. #1
    CoeurD'Alene, Idaho
    Question Modifier Quandry for Medicare
    Medical Coding Books
    This claim keeps getting kicked out. We gave a Pneumovacc 90732 with the G0009(Admin) and a Hep V Vaccine 90746 with 90471(Admin) and then a TB placement 86580. I have tried using 90472 in place of the 90471 secondary vaccine and got a denial. I then tried putting a 51 on the 90471 and 59 on the 86580 and got a denial. Can someone please tell me how to get this claim paid and where and what modifiers to use? I am pulling my hair out about this one!!:
    Last edited by moremopars1; 11-10-2011 at 09:49 AM. Reason: misspellng

  2. #2
    Seacoast- Dover New Hampshire
    Hep A is not covered by Medicare neither is TB
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  3. #3
    Overland Park, KS
    I am going to assume here that when you state you are using code 90746, you are giving the Hep B vaccine, correct? Medicare does cover the Hep B vaccine (check your carrier for coverage criteria), but I think your problem here is the use of code 90471. The Hep B vaccine requires the administration code of G0010.

    Hope this helps.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

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