Wiki H1n1 admin coding quest

[LADY_SETSUNA_CJ]

Hello,

We have been billing out the H1N1 with a 90470 admin code and when other immz are giving a 90471 and 90472. UHC has been paying the 90470 and 90472 and denying the 90471 as bundled. I've checked our encoder program and it says they can be billed together, however even after appealing UHC will still not pay the 90471. Any ideas? Am I billing this correctly?

Thanks in advance,
Cheryl, CPC-A

 

[mitchellde]

You cannot bill a 90470 and a 90471 together. The instruction that is missing from ost CPT books is that 90470 is an initial code as is the 90471 and the 90472 appends to both. This is due to the fact that most books were published prior to the 90470 being activated in 09. This was later clarified on the AMA website as well as CMS. So if you have 3 vaccines with one being H1N1 then you would have
90470
90472
90472 59

 

[LADY_SETSUNA_CJ]

Thanks so much! I assumed this was the case but I just wanted to make sure.

Cheryl, CPC-A