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flu vaccine

  1. #1
    Default flu vaccine
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    If you bill a EM and flu vaccine and the administration together do you have to use mod 25 on the ov Someone says yes and someone else said no this is when the dr sees the pt I am not talking about just a 99211

  2. #2
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    My experience has been that yes you do need to append the 25 modifier to the office visit.
    Medicaid will pay the claim from the bottom up and will pay either the office visit or the administration, whichever it reaches first. It will not pay both.
    Blue Cross has been requiring the 25 modifier with both 90772 and 90471 according to my payment posters.

  3. #3
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    Yes, it is best to use a modifier 25 to show the E/M is seperate from the administration of the flu vaccine. If you do not some carriers will pay the administration and deny the office visit. There may be a couple that do not require it but it will not hurt to add it, it's better to be safe then sorry.

  4. #4
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    We don't use the modifier because the e/m code has it's own diagnosis attached to it. We have not had any problems with NC Medicaid or any other carrier with this. I'm in pediatrics and this happens year round with our practice... not just with flu vaccines... often a child is in the office for a problem visit and in reviewing the chart the doctor will determine it is time to update or give a booster of a vaccine while the child is here.

    Hope this helps.
    Barbara Haskins CPC

  5. #5
    Location
    Duluth, Minnesota
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    1,133
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    we always modify the E/M when immunizations are given. Documentation supporting E/M and immunizations or course! We link the dx's accordingly. We do this for ALL insurances.
    Donna, CPC, CPC-H

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
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    Quote Originally Posted by dmaec View Post
    we always modify the E/M when immunizations are given. Documentation supporting E/M and immunizations or course! We link the dx's accordingly. We do this for ALL insurances.
    We do the same...it avoids appealing the denial of either the admin or E/M.
    Lisa Bledsoe, CPC, CPMA

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