Wiki G0008 and Other Vaccine

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dballard2004

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This question has been asked before on this forum and there appears to be a contridiction in the answers. If a Medicare patient is given a flu vaccine and an additional vaccine as well (for the sake of this example, let's say polio), you code G0008, 90658, 90471, and 90713. Now, which administration code gets the modifier 59? The G0008 or 90471? I'm confused. Both codes appear on the NCCI edits as mutually exclusive and depending on which edits you look at, G0008 appears in column two with 90471 in column one showing that they can be separated by a modifier, but then 90471 shows up also in column two with G0008 in column one. Help!
 
In my opinion,

I would coded this scenario for Medicare patient as :
90713 - V04.0
90471 - V04.0
90658 - V04.81
G0008 - V04.81

As per definition CPT 90471 says Immunization administration 1 vaccine (single or combination vaccine/toxoid) & G0008 clearly says Administration of influenza virus vaccine.

I don't think there is need of modifier 59 for any of above CPTs as they are clearly distinguished by their deffinition. As per our observation, we have also submitted claim in same manner but till not received any denial.

All the Best !
 
Since 90471 is an initial vaccine, I would code it this way, without any modifiers:
G0008
90658
90472
90713
We have had many discussions with our providers and payes, and this is our best recommendation.
 
For the administration codes, I would code G0008 as the influenza and 90472 for any subsequent vaccines.
 
According to the NCCI edits, you can't report G0008 and 90472 together for the administration of a second vaccine. You must report 90471 for the second vaccine (excluding Hep B and pneumonia that have their own HCPCS G codes). Do you append modifier 59 to G0008 or 90471? There is conflicting info on these forums.
 
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dballard, i completely agree with your initial statement relating to this matter... example:
here in our office, if a patient has medicare and comes in for a flu shot...
we bill 90658 & G0008mod-59 dx V04.81...in addition if patient also gets a pneumococcal shot at the same visit then we bill 90732 & G0009mod-59 dx V03.82.

now if medicare patient comes in for flu shot, we bill 90658 & G0008mod-59 & if at same visit patient also gets the polio (as you used for example) we would bill the
90471mod-59 & 90713...

the 90472 is used **in conjunction** when 2 different vaccines are given, which would call for 2 immunization administrations

so 90471 is for the 1st vaccine & the 90472 is for the additional vaccine in conjunction

regarding mod-59, if pt comes in for a vaccine we add the mod-59 to the adm code... & if pt comes in for 2 vaccines which is 2 adm codes with add the mod-59 to both the adm codes, not the vaccines.

we haven't had any issues, and are receiving payment in a timely manner esp with mod-59being added.

let me know
 
So, just so I am clear here (I just want to make sure I have this correct), you put modifier 59 on both the G code and the code for the addtional vaccine administration? Why both codes? I thought that -59 only went on the subsequent procedure(s)?

Am I making this harder than it should be?
 
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We have an outsourced billing dept who keeps on the changes with the ins companies... to date, if will billed a Medicare patient getting the flu shot & the pneumococcal vacc on the same visit, it would look like:

90658
G0008 -59 adm
90732
G0009 -59 adm

...if patient received flu shot & polio (as you used) it would look like:
90658
G0008 -59 adm
90471 -59 adm
90713

if a patient came in WITHOUT Medicare & received 2 injections, example:flu shot & Tdap, it would look like:

90658 flu
90471 -59 adm
90715 Tdap
90472 -59 adm
 
In the first and second example, I don't see why -59 is being appended to the first vaccine, the subsequent vaccine is the distinct procedure.

Am I missing the boat here?
 
Another spin here....if the patient has a laceration repair done and we administer the flu, pneumonia, and Td vaccines, would we append -59 to all the vaccine admin codes in this case?
 
why is the modifier 59 being used twice.? why would you use it on the flu and then again on the next administration of a vaccine?? Shouldnt the second procedure have the 59 on it not both of them. So far I have been lucky Patients seem to be coming in for the flu and thats the only one so far.


Donna J Vitone Weber CPC CMA
 
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