Wiki Medicaid

[Jetzabel Nassiry]

Hello everyone, can someone please tell me why??? Medicaid is not reimbursing for CPT code 99401, when billed with 90460. Pt. came in for a WCC and got shots 90649 and 90686. I billed a 99384 = WCC
99401FP=Counseling for hpv
90649= HPV shot
90686= FLU shot
90460X2=Admin shots


I called Medicaid and was told that 99401 and 90460 can't never be billed together, I linked 99401 and 90460 to the shoots. Should I use 90471 and 90472 for shots administration and use 99401 for the counseling? Someone please help

 

[dclark7]

The description for 90460 is "immunization administration .........with counseling by physician ......", so CPT is assuming when you use this code that you are also counseling the patient. The description for 99401 is "Preventive Medicine counseling and or risk factor reduction intervention...(separate procedure)..", so by definition you are also counseling the patient. Then you have your WCC 99384 which by definition includes "age and gender appropriate ......counseling/anticipatory guidance/risk factor reduction.....".

All in all you now have three codes which all include counseling (99384 and 99401 are bundled into 90460, but modifiers are allowed), the coding would depend on the provider's documentation of how much time was actually spent in the counseling specifically for HPV. Based on what you've supplied (and I don't have access to the notes so this is based on my experience as well as what you've written), I would code:
99384,25
90460 x 2, 90649, 90686

I hope this is helpful for you.