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Pass through and non pass through coding claim edit on 90710 stating needs billed with primary procedure. It was billed with 90460 and 90461. Not sure what this pass through non pass through denial means.
Are there actual CARC and/or RARC codes, that were listed with the coding claim edit you received for 90710? Who is the insurance carrier and what state is the carrier in?
Knowing what codes were applied to the claim edit and the information on who the carrier and what state the carrier is in will help the community answer your questions in more timely manner and with more specific information. Also, some people will skip responding to a question if the details in the posted question are minimal because it is not worth the time to try and research the question, and/or worth the time to respond to you asking for these kinds of details.
That said, all I can say is that assuming your patient is 18 y/o or younger billing 90710 with 90460 x 1 & 90461 x 3 appears to be accurate based on the guidelines for all 3 CPT codes. I'm uncertain what this error means in relation to this claim or what might be causing the claim edit to apply to the services listed in your post. I would be happy to review any additional information you post regarding this issue and see if we can get to the bottom of this issue.
Is the immunization admin correctly matched with the vaccines? Are they looking for 9047_ area of codes? Should the vaccine be on the claim, was it obtained through a vaccines for children type plan such as in Medicaid scenarios? Are the correct # and administration codes matched up? Are the diagnoses correctly matched?
Was counseling provided by the provider?
How many vaccinations were administered?
What was the route of administration?
How many components/toxoids were there in each vaccination?
I agree with the advice above also. When posting questions, please include more information and be more specific. It is difficult for those that want to help to answer vague questions such as this. Also, when working claim edits, denials, and rejections it is helpful for individuals to do some research and try to figure it out, and then indicate what was tried before asking for help here.
Basic questions are: 1. Was it coded correctly according to the documentation? 2. Who is the payer? 3. What was the reason code or adjustment/rejection/denial reason? 4. Did I look up the payer policy for these codes? etc.