Internal Medicine Coding Alert

Answer: Yes, thats correct. Medicare has changed its mind again. When a flu, pneumococcal or hepatitis B vaccination is administered to a Medicare beneficiary on the same day as an evaluation and management (E/M) service, modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) no longer needs to be attached to the E/M code, according to a program memorandum to carriers from the Health Care Financing Administration (HCFA). In the Correct Coding Initiative (CCI) version 6.3, which went into effect on Oct. 30, 2000, HCFA required the use of the modifier with vaccination codes G0008 (administration of influenza virus vaccine when no physician fee schedule service on the same day), G0009 (administration of pneumococcal vaccine when no physician fee schedule service on the same day) and G0010 (administration of hepatitis B vaccine when no physician fee schedule service on the same day). Denials were issued to claims that did not include it. Now, carriers have been ordered to remove those edits from their systems.

If one of the three HCPCS codes [G0008, G0009 or G0010] is billed with an evaluation and management (E/M) code on the same day of service, previously we required modifier -25 to be appended to the E/M code for payment. This requirement has now been rescinded, reads HCFA transmittal B-00-73 (dated Dec. 18, 2000).

Practices filing claims without modifiers on or after Oct. 30, 2000, and received denials may resubmit their claims with the E/M codes and the vaccination codes for reconsideration.

The memo goes on to remind providers, however, that an E/M code should not be billed for a vaccination procedure unless a separately identifiable E/M service was performed.

A copy of the memo can be found on the Internet at http://www.hcfa.gov/pubforms/transmit/b0073.pdf.