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Need Help Please!

  1. Unhappy Need Help Please!
    Medical Coding Books
    A Pt Was Seen By Ma Only And Gave The Pt Zostavax And
    We Submitted To The Ins. As

    99211
    90736
    G0008

    Dx- V05.4

    We Got A Call Today From Blue Cross Saying That We Have To
    Add A Modifier To 90736 In Order To Get Paid By Blue Cross. Keep In
    Mind Pt Has Medicare As Prim And Bc As 2ndry. Can Anyone Tell Me
    What Modifier There Talking About ? And Bc Said They Can't Tell Us
    Which Modifier But Is The 2nd One In The Modifier List. I Don't Know Why We Need Modifier It Was Nurse Visit Only.

    Thank You All In Advance.

    Msmaddy

  2. #2
    Default
    Quote Originally Posted by madlen View Post
    A Pt Was Seen By Ma Only And Gave The Pt Zostavax And
    We Submitted To The Ins. As

    99211
    90736
    G0008

    Dx- V05.4

    We Got A Call Today From Blue Cross Saying That We Have To
    Add A Modifier To 90736 In Order To Get Paid By Blue Cross. Keep In
    Mind Pt Has Medicare As Prim And Bc As 2ndry. Can Anyone Tell Me
    What Modifier There Talking About ? And Bc Said They Can't Tell Us
    Which Modifier But Is The 2nd One In The Modifier List. I Don't Know Why We Need Modifier It Was Nurse Visit Only.

    Thank You All In Advance.

    Msmaddy


    Msmaddy,

    That doesn't sound right to me you should have the modifier (25) on the visit not the immunization.

    Why are you billing a minimal visit anyway? Did the nurse just give the immunization. The g0008 is not the correct code thats the admin code for the flu shot. You need 90471 not g0008.
    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"

  3. #3
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    GY modifier on the zoztavax - Medicare isn't going to pay it. You'd need a .25 on the office also - however, I don't see an OV - I see immunization only (from the info you provided)
    {that's my opinion on the posted matter}
    Donna, CPC, CPC-H

  4. Default
    Yes, the nurse only gave the immunization pt was not seen by the Dr. So
    do we still use mod 25 and use 90471 for admin of immun.

    Thank You Again
    Msmaddy

  5. #5
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    if you're going to charge the E/M, yes - you'd need a .25 modifier on it - and yes, it's the 90471 admin code
    Last edited by dmaec; 08-14-2008 at 06:37 AM.
    Donna, CPC, CPC-H

  6. #6
    Location
    ENGLEWOOD/DENVER
    Posts
    2,338
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    you mentioned that the patient was seen by the MA...I dont believe that MA's qualify as a "nurse" to justify a "nurse" visit.

  7. #7
    Location
    Greeley, Colorado
    Posts
    2,045
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    You should not code 99211 with administration codes... Also, you need to get the denial from Medicare first before billing the secondary (I believe), so it needs to go to Medicare first to get the denial. And G0008 is not the admin code as Donna said.
    Lisa Bledsoe, CPC, CPMA

  8. Smile
    Dear Donna,

    I used the GY Modifer on Zostavax as you mentioned and we resubmitted
    the claim as:

    99211
    90536
    90471

    FYI
    The BC ins person called us back saying that was a wrong modifier, she
    said again it the 2nd modifier in the list. We Asked which book cpt or
    hcpcs? She said I can't tell you then, she whispered cpt book. So we gave
    the modifier 22, And she confirmed it that was the right code. Modifier 22
    it seems to be for procedure that require more work. Are you sure that it is
    OK to use modifier 25 with level 99211 since it was nurse only visit and all she did was gave the vaccine?

    Thank You Again
    MsMaddy

  9. Default
    We were always told that in order to charge a nurse visit, there has to be documentation in the patients record that the nurse performed an exam of some sort. If all the MA did was give an immunization you cannot charge was is considered an E/M (99211). (I am also not sure about MA's charging a nurse visit.) From what you said you should only be charging the administration code and the zostavax vaccine. By the way, Medicare part D does pay for this, so if the patient has Medicare Part D it is covered.

  10. #10
    Location
    Duluth, Minnesota
    Posts
    1,133
    Default
    Quote Originally Posted by madlen View Post
    Dear Donna,

    I used the GY Modifer on Zostavax as you mentioned and we resubmitted
    the claim as:

    99211
    90536
    90471

    FYI
    The BC ins person called us back saying that was a wrong modifier, she
    said again it the 2nd modifier in the list. We Asked which book cpt or
    hcpcs? She said I can't tell you then, she whispered cpt book. So we gave
    the modifier 22, And she confirmed it that was the right code. Modifier 22
    it seems to be for procedure that require more work. Are you sure that it is
    OK to use modifier 25 with level 99211 since it was nurse only visit and all she did was gave the vaccine?

    Thank You Again
    MsMaddy
    MsMaddy - Like I said, I don't see an OV - on what you presented before. I see an immunization only. I wouldn't code the 99211 BUT as I said, if you do, if you have documentation supporting it - it would need a .25 due to the immunization.
    Also, my zoztavax CPT code I use is 90736, not 90536 (there isn't a 90536)
    the 90736 needs the GY on it for Medicare.
    there isn't any service provided in your scenario that justifies the use of the 22 modifier. 22 modifier is NEVER appended to the office visit and the injection does not require "more work"... I don't usually say someone is wrong - but the lady at BCBS is ...... well, wrong...
    if I was coding this I would put:
    90736.GY
    90471
    with dx:V04.89

    {that's my opinion on the posted matter}
    Last edited by dmaec; 08-15-2008 at 02:30 PM.
    Donna, CPC, CPC-H

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