Page 2 of 2 FirstFirst 12
Results 11 to 18 of 18

Need Help Please!

  1. #11
    Location
    Pennyrile Regional Chapter
    Posts
    21
    Wink
    Exam Training Packages
    If only the vaccine is given, there is no need to code the visit. When coding vaccine, you also have to code the administration as well. Use code 90736 for vaccine and 90471 for administration. This is not a flu vaccination so you would not use G0008. There should be no modifier if no E/M service was rendered.

    It states in my step-by-step coding book "IF THE ONLY SERVICE IS ADMINISTRATION OF A VACCINE AND NO OTHER SERVICE IS PROVIDED, DO NOT CODE AN E/M. RATHER ONLY CODE FOR THE ADMINISTRATION OF THE VACCINE AND THE VACCINE PRODUCT."

    It also states the "If a E/M service was provided, some third party payers require a -25 modifier on the E/M code." It would not be -22 modifier.

    Also, it states "FOR MEDICARE PATIENTS, YOU WOULD ONLY REPORT AN ADMINISTRATION CODE FOR AN IMMUNIZATION WHEN NO OFFICE SERVICE CODE WAS REPORTED. MEDICARE POLICY STATES THAT IF AN OFFICE SERVICE IS REPORTED, THE OFFICE SERVICE CODE INCLUDES THE ADMINISTRATION OF AN IMMUNIZATION."

    I hope this helps some.

  2. Red face
    Donna,

    Thank you for your input, as far as documentation for ma visit only yes
    we do have documentation. And I am sorry about zostavax code it was a typo. We'll just wait for the claim that the biller sent through we'll see
    if it gets denied. I agree with about the modifier 22, and we did not append it
    to the office level 99211 it was on 90736 according BCBS lady. so
    if it become denied should I coded likt this?

    99211-25
    90736-gy
    90471

    Thank you again for your help!

    MsMaddy

  3. Default
    Quote Originally Posted by marygoodsell View Post
    If only the vaccine is given, there is no need to code the visit. When coding vaccine, you also have to code the administration as well. Use code 90736 for vaccine and 90471 for administration. This is not a flu vaccination so you would not use G0008. There should be no modifier if no E/M service was rendered.

    It states in my step-by-step coding book "IF THE ONLY SERVICE IS ADMINISTRATION OF A VACCINE AND NO OTHER SERVICE IS PROVIDED, DO NOT CODE AN E/M. RATHER ONLY CODE FOR THE ADMINISTRATION OF THE VACCINE AND THE VACCINE PRODUCT."

    It also states the "If a E/M service was provided, some third party payers require a -25 modifier on the E/M code." It would not be -22 modifier.

    Also, it states "FOR MEDICARE PATIENTS, YOU WOULD ONLY REPORT AN ADMINISTRATION CODE FOR AN IMMUNIZATION WHEN NO OFFICE SERVICE CODE WAS REPORTED. MEDICARE POLICY STATES THAT IF AN OFFICE SERVICE IS REPORTED, THE OFFICE SERVICE CODE INCLUDES THE ADMINISTRATION OF AN IMMUNIZATION."

    I hope this helps some.
    I don't understand why 99211 can not be used to ma only visit, the doctors is present on site and it is his request for the administration even though he does not go into the room only MA does and provide the vaccine. Thats why we use level I 99211. According to the cpt book and the coding school I attended that is the case.

    Thank for your help!

    MsMaddy CPC-A

  4. #14
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    Quote Originally Posted by madlen View Post
    Donna,

    Thank you for your input, as far as documentation for ma visit only yes
    we do have documentation. And I am sorry about zostavax code it was a typo. We'll just wait for the claim that the biller sent through we'll see
    if it gets denied. I agree with about the modifier 22, and we did not append it
    to the office level 99211 it was on 90736 according BCBS lady. so
    if it become denied should I coded likt this?

    99211-25
    90736-gy
    90471

    Thank you again for your help!

    MsMaddy
    MsMaddy - *I*wouldn't code the OV (99211), doesn't matter if the doctor is on site, this service appears to be an "immunization only" visit. *I* would only code out the 90736.GY & 90471 with DX:V04.89. However, if you're still going to code out the OV - then yes - it should go out as you have it above
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  5. #15
    Location
    Pennyrile Regional Chapter
    Posts
    21
    Exclamation
    If she codes for the OV, is that not fraud?

  6. Default
    Quote Originally Posted by marygoodsell View Post
    If she codes for the OV, is that not fraud?
    Some insurance adjust of the 99211 and others like Kaiser require us to use 99211 even if it is MA visit. Look at the 99211 in cpt book, it does not require for Dr to be present, it is only for a five minute spent performing or supervising these services and it is not a key component.

    I hope this helped!

    MsMaddy

  7. #17
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by madlen View Post
    Some insurance adjust of the 99211 and others like Kaiser require us to use 99211 even if it is MA visit. Look at the 99211 in cpt book, it does not require for Dr to be present, it is only for a five minute spent performing or supervising these services and it is not a key component.

    I hope this helped!

    MsMaddy
    True - but if it is an immunization/injection only visit then you should not be coding 99211. Check out this link: http://www.trailblazerhealth.com/Pub...9211JobAid.pdf
    Lisa Bledsoe, CPC, CPMA

  8. Default
    RI Blue Cross uses -22 modifier on injections for adults to show it is not a state supplied vaccine. It really isn't a correct modifier, but that is how you get paid by BS (RI)

Page 2 of 2 FirstFirst 12

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.