Modifier Coding Alert

Question: A Medicare patient is coming in to our office for a tetanus shot, but he has no correlating injury. My physician or nurse practitioner will administer the tetanus toxoid (90703). What modifier will I report with this encounter?

Massachusetts Subscriber

Answer: Because the patient is a Medicare patient and there is absence of an illness or an injury, your family physician will have to have the patient sign an advance beneficiary notice (ABN) before he or the nurse practitioner can administer the vaccine. Medicare does not cover tetanus vaccines under Part B, unless the patient has sustained an injury such as a puncture wound from stepping on a rusty nail.

You need to attach modifier GA (Waiver of liability statement issued as required by payer policy, individual case) to the vaccine administra–tion code. This modifier

communicates that your provider has a signed ABN.

With the ABN on file, you need to report the vaccine (90703, Tetanus toxoid adsorbed, for intramuscular use) and the administration of the vaccine.

If the patient is 18 years of age or younger, you’ll choose 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered). If the patient is older than 18 years, you’ll choose 90471(Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]).