Wiki Immunization administration codes with E&M-out patient

[cwestman]

I'm hoping someone can clear up a conundrum for me. I have been told by our Billing department that the use of admin codes for vaccines are not to be submitted when done with an E&M .
As I understand the CPT codes 90460 for age 18 and under and 90461 for components and 90471 and 90472 for components for pt 19 and up are used when the patient/care giver is counseled regarding Immunization(including G0008/G0009 for medicare) Adding Modifier 25 on the EM is required.
Looking back at claims submitted for this year I'm finding that these codes have been removed, except for VFC When I questioned the billing dept I was advised that those codes can not be submitted with an E&M ,that 3rd party payers reject them. I find this hard to believe as even with VFC and use of SL modifier Medicaid covers the adm/counseling fee
I'm hoping someone might be able to shed more light at this point I feel we are missing revenue
Much appreciate your time
Cheri-CPC-A

 

[erjones147]

In general, your billing department is wrong

Some specific payors may not pay for immunizations, but it is incorrect to just say, "Don't ever bill immunization admin codes"

 

[thomas7331]

Are you billing for an office or facility-based practice? If your practice is facility-based, vaccine administration charges would be billed by the hospital on a UB claim so you wouldn't have them on the professional claims, but I agree that it would be incorrect to just not bill them at all.

 

[istanstu]

Besides where you are billing from our state Medicaid manual has specifics on how to submit, lets say pt under age 19 received 4 vfc vaccines and a sick or a well visit we have to code 90460 times 1 unit 90461 times 2 units (max limit 2 despite of receiving more vaccines) and the em. this is per our state vfc policy. we also have to report the zero dollars CPT code for the corresponding vaccine.since our billing system is finicky we have it set to submit all zero dollars charges. Some of my managed Medicaid's will actually reject my claims if charge entry keys more admins then appropriate through vfc program.

 

[cwestman]

Thank you for your help ,I very much apprecaite your input and time,thanks again!

Thank you for your responses! The facility that I work for is an article 28 hospital based, with out patient services for PCP and ambulatory surgical as well as inpatient care.
I do code for the out patient PCP I have noticed for NV for just flu vaccines billing is leaving the E&M on for adm codes, as well leaving on the adm code for VFC.I understand as well capitation is a factor ,however not enough to remove all fees regardless (except VFC program)just did not make sense to me.
Again appreciate your in put I have 30 yrs of office nursing experience ,however only a few months as a certified coder ,with a desire to succeed in meeting all compliance for guidelines with 3rd party payers and receive appropriate reimbursement for Providers is challenging, Thank you again!