Wiki G0008 Coding Difficulty - Medicare

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mariannegonzalez01

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I have two claims utilizing G0008 - it has been kicked back twice now. Medicare said to use modifier, so we did, but they kicked it back again. It's being used with 90472. Second claim is G0008 with Q2038. They kicked this one back also. Need help to finally get these claims paid for.
 
Like the previous poster stated you're billing two admin fees, but there isn't a charge for what was administered? I have to change 90472 to 90471 if 90471 hasn't hit the account for that day. Sometimes our charges get split off onto separate claims depending on how the providers enter the charges. If 90471 went out the door already, I'll leave 90472 alone. Maybe, your charges are being split up?

When the flu shot is billed with an office visit, I have to append a modifier to the office visit.

I'm not sure why there would be problems with your second claim. No modifiers go out when I bill just those two charges.
 
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The original claim (G0008) which had Modifier 22 attached was kicked back first because there was an additional immunization under 90471 and a J-code. So now - she submitted G0008-22 with 90472. The 90472 confuses me because it is "each additional", so I don't believe she should be using this. I think she needs to indicate the immunization itself. The other claim was submitted with G0008 and Q2038 (which is the immunization itself). This one was kicked back too. The explanations on the Medicare RA's are very criptic!! Any input would be greatly appreciated.
 
Sorry, I'm still a little confused :(

I think we need to know what all was administered. The flu vaccine is a given, of course. I'm curious what J-code was submitted.

The only modifier I've used is modifier 59 on the G-codes. If your provider administered two vaccines your carrier may want this:

G0008-59
90471
Vaccine
Vaccine

90472 is not an addon code for G0008.

That's the only suggestion I can think of. Someone else may be able to help. Good luck!
 
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