lcoleman101
New
We recently got a denial from Cigna disallowing the 90460 when billed with 90651. They use the Clear Claim Connection through McKesson and when I went on there it also disallowed the code.
We billed
99394-25
90651
90460
This is the way we have always billed it but the edit response McKesson give is:
Response:
According to CPT guidelines published by the AMA, "Codes 90476 - 90748 identify the vaccine product only. To identify the administration of a vaccine/toxoid, the vaccine/toxoid product codes 90476-90748 must be used in addition to an immunization administration code(s) 90460-90474." In addition, according to CMS, codes G0008 - G0010 represent vaccine administration only. Thus, these codes may also receive a recommendation for denial when submitted without their primary vaccine or toxoid supply code.
This claim line was recommended for denial because the vaccine product code was not submitted with the appropriate associated vaccine administration code.
Therefore, procedure 90460 is disallowed.
Anyone having this issue or can assist in understanding why and what to do?
We billed
99394-25
90651
90460
This is the way we have always billed it but the edit response McKesson give is:
Response:
According to CPT guidelines published by the AMA, "Codes 90476 - 90748 identify the vaccine product only. To identify the administration of a vaccine/toxoid, the vaccine/toxoid product codes 90476-90748 must be used in addition to an immunization administration code(s) 90460-90474." In addition, according to CMS, codes G0008 - G0010 represent vaccine administration only. Thus, these codes may also receive a recommendation for denial when submitted without their primary vaccine or toxoid supply code.
This claim line was recommended for denial because the vaccine product code was not submitted with the appropriate associated vaccine administration code.
Therefore, procedure 90460 is disallowed.
Anyone having this issue or can assist in understanding why and what to do?