# Modifiers with Level 5, prolonger service, fingerstick, and flu vax and admin



## MandyBMC (Sep 23, 2016)

Hi all,

One of our providers is billing:
99215 - level 5 established patient e/m
99354 - prolonged service
82962 - glucose fingerstick
90661 - flu vaccination
90471 - vaccine administration

What I am confused on is what modifiers to use in this situation, and where. I believe 59 would go on the vaccine admin, but would 25 go on 99215? Would anything need to go on the finger stick as well? 

Any help would be appreciated!

Thank you,
Mandy


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## danskangel313 (Sep 23, 2016)

MandyBMC said:


> Hi all,
> 
> One of our providers is billing:
> 99215 - level 5 established patient e/m
> ...



99215 bundles with 90471, so the modifier would be attached to the 99215. However, does the documentation really meet such a high E/M level (99215 + 99354)?? If the patient is there for the vaccine and a glucose test, is there something _substantially_ more happening? The E/M service (99215 + 99354) would have to be a significant, separately identifiable from the vaccine administration (90471) counseling in order to use a mod to break the bundle.


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## MandyBMC (Sep 26, 2016)

danskangel313 said:


> 99215 bundles with 90471, so the modifier would be attached to the 99215. However, does the documentation really meet such a high E/M level (99215 + 99354)?? If the patient is there for the vaccine and a glucose test, is there something _substantially_ more happening? The E/M service (99215 + 99354) would have to be a significant, separately identifiable from the vaccine administration (90471) counseling in order to use a mod to break the bundle.



Thank you for your insight. Yes, there is a lot going on with this patient which constitutes the level 5, prolonged service, as well fingerstick, flu vax, and vaccine admin. This being the case, you believe we would only put a modifier on 99215?


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## MandyBMC (Sep 29, 2016)

If anyone else has any input on this scenario, I'm all ears!


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## danskangel313 (Oct 1, 2016)

If there's documentation to back it up, the 25 mod would go on the 99215. I don't see any other bundles besides the 99215 with 90471.


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## MandyBMC (Oct 4, 2016)

Thanks much!


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