Wiki 01012013 NCCI Change

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hsims

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As of 01/01/2013 well visit codes are now included in the vaccine administration codes... Can anyone direct me to some written rationale for this change? I cannot really understand how the totality of the well visit is considered to be included in the injection administration and I forsee a lot of providers just smacking a 25 modifier on there every time they bill a well visit...
Well visit codes 99381-99387, 99391-99397
Injection Admin codes 90460-90461, 90471-90474

Thanks in advance!
 
See page 479 in CPT manual.
" If a significantly seperately identifiable Evaluation and Mangement service (eg, office or other out patient services, PREVENTATIVE MEDECINE services) is performed, the apropriate E/M service code SHOULD be reported in addition to vaccine and toxoid administration codes."

Think this justifies the 25 mod.
:)
 
press release from the academy of pediatrics regarding the CCI edit and preventative codes with vaccines...

"While the Academy is urgently working with National Correct Coding Solutions - the CMS contractor for NCCI edits - to have the edits suspended on all preventive medicine service codes (99381-99385 and 99391-99395) with all immunization administration codes (90460 and 90461, 90471-90474). It should be noted that the edits are currently locked in and will continue to be in effect for Medicaid, Medicare, and private payers that implement CMS coding policies until such time that AAP advocacy efforts are successful. Over the past several days, the AAP has been in telephone contact with the highest levels of the CMS contractor responsible for the NCCI edits and has delivered a formal letter demanding retraction of these edits.


Therefore, effective immediately and for all claims submitted after January 1, 2013, AAP urges its members to append modifier 25 to the preventive medicine service code (99381-99395) when it is reported in conjunction with any immunization administration service (90460-90461; 90471-90474).

A modifier 25 should also be appended to other non-preventive medicine E/M services (eg, 99201-99215) when reported in conjunction with immunization administration -- but only when the E/M service is significant and separately identifiable.

We understand this is an administrative burden for you and your staff. The AAP is working diligently to unlock this change and will forward additional information on this issue as it becomes available.

Please contact the AAP Coding Hotline with any questions or issues:"
 
01012013 ncci change

Thanks All, I was just investigating this for our pediatricians.

Although I agree with the AAP that this is not appropriate. I am not confortable with adding this modifier as this modifier has been known to be over utilized.

But is there any other choice? :confused:
 
I really dont see any other options but to add the 25. :( It is however reassuring that the it does state in the CPT manual to add the 25, and that the AAP has made CMS aware of the issue and are pushing the issue to have this (NCCI edits) changed!
Chin up I believe this will be corrected....eventually!
Happy Coding :)
 
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