Wiki Help with coding error

[june616]

The dx are:

257.2 (hypogonadism, testicular)
V04.81 (vaccine for influenza)

I coded:
96372 (for dx 257.2)
90471-59 (for dx V04.81)
90658 (for dx V04.81)


We never code the testosterone med along with 96372 because the pt supplied the medication himself and we do not bill the ins for that. Ins denied 96372 due to coding error. Any help for where I went wrong?

 

[cdr4life]

hi

i work for a dr office in az and i think i know what you're talking about

when a patient comes to our office for this, i put a modifier 25 on the office visit. if there is no office visit, then no modifier needed.

example:

99213 25 461.9
96372 257.9
90658 V04.81
90471 V04.81

 

[kvangoor]

Seems most payers are bundling the 96372 into anything else done that day (office visit or any other vaccine injections) I would appeal the denial with notes showing why you are billing the 96372 in addition.

 

[mitchellde]

If the patient is supplying the med I still list the J code with a $0 (or a $.01) charge to show tat a separate med was given. It works every time!

 

[smontague]

I would either add the j-code with a zero-charge as others suggested, or try putting the -59 modifier on the 96372 rather than on the vaccine admin code.