Wiki Multiple vaccines administrations same day

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DMAndre

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Help please!!

We are receiving denials when 2 or more vaccines are given on the same day for Mcr. For example G0008 billing with 90472. Denying 90472 as missing primary cpt. Per encoder the "g" codes for Mcr are primary to 90472. What am I doing wrong??
 
I understand that. But if you are billing for a flu or pneumo to Mcr than you must use the "G" codes for the administration for those vaccines. So, say the doc is giving a flu shot, you would bill 90658 w/G0008. Now he is also giving a tdap for let's say an open wound. Now you would need to bill the 90472 (second administration) with the 90715. Correct? The second admin is what they are denying. Thanks for your help!
 
I bill 90471 to Medicare for those Vaccines. I don't use the G code. My only suggestion is to bill the G code and the 90471 instead of 72
 
DMAndre

Your coding is correct as
90658 w/G0008
90715 with 90472

The G codes follow the same CPT rules as the 90471-90472 with intial and additional. The problem is that G0008 and G0009 are not defined as intial or additional but just to the type of vaccine

So don't understand why but MCare for whatever reason considers the G0008 and 90472 as duplicating. You need to add mod -59 on the 90472

Look at this link but scroll down to the bottom to the Mcare examples and to this statement.

Note: For Medicare, add modifier 59 to any CPT® administration code (90465-90474) if it is on the same claim as a HCPCS G-code. Check with other payers to see if they also require a modifier 59.

Direct link: http://www.codapedia.com/articlePrint.cfm?id=485
 
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You need to use 90471 regardless of any G code used. You will need the 59 on the G code, this is per the CCI.

Since the G codes do not specify that it is an initial administration, it is considered secondary to whatever other vaccine is administered, that is why you need the initial, 90471, when more than one is given.

If you haven't done so already, go to the link provided by sbicknell, there is an example of how to bill Medicare. You will see that they have listed 90471 with the G code and then 90472 for any additional vaccines that need to be billed.

Just don't forget your 59 on 90471 or you will get another denial.
 
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