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Flu Season Coming

  1. Default Flu Season Coming
    Medical Coding Books
    I'm going around in circles with this one....
    If we are billing 90658, what is the appropriate injection code? 90471 or
    G0008. It used to be that only Medicare would accept G0008 and private companies would not but now all payers are required to accept level II codes.

    I can't seem to find anything that differentiates the two when billed with 90658. To top it off, our doctors seem to get paid whether they bill with 90471 or G0008, and the reimbursement is approx the same.

    Anyone have any info about this?

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Well...you're right. This subject always seems to be a debate. I have found that this really becomes carrier specific. Every year, we have to go to our major carrier websites to find out how they want this filed; although, I do find that many carriers still want 90471. Traditionally, G0008 was for Medicare but some did deny our claims with 90471. In addition, I did see that some carriers would pay for either or. It will be interesting to see if there will be revisions to insurance medial policies since so many carriers are following CMS guidelines (or they proclaim to).
    Rebecca CPC, CPMA, CEMC




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  3. #3
    Default
    I have never really had problems with 90471 even with Medicare. As long as it is a medical necessity.
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  4. #4
    Location
    NCF Gainesville
    Posts
    64
    Default
    I have never had Medicare payon 90471, always G0008. All others we bill the 90471 and see what happens.
    Jeni Smith, CPC, CPMA

  5. Default
    Seems to be regional. Thanks for your input!

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