Wiki Preventative visit with immunizations

[vhammons]

I put modifier 25 on our preventative visits and am getting admin fees denied. I'm not sure what I am missing. Everything I can find tells me to do it that way. They are Wellmark Blue Cross and Blue Shield Members. The codes used were 99394 and 99384. Any help would be appreciated. I'm new to coding, and am really struggling with this.

 

[vfoley]

modifier 25

You can use modifier 25 on visit but it has to be a separate identifiable reason for
the visit to do this. And your E& M visit documentation has to be good and detailed.
Then, you can bill this visit and still get paid for administration codes. hope this helps.

 

[BarbRoberts]

what is the reason code from your remit? if it's all claims call the insurance they may not accept the admin codes you are using or there may be additional modifiers that need attached to the serum code. Some carriers we deal with will only pay on 90471/90472 combination regardless of age I am not familiar with this blue cross plan. Is this a regular blue cross plan or is it a local medicaid HMO? Are they paying on the serum codes? If the denials are random the first thing I would check is to see if another family received shots on the same date of serv. we are having issues with our local blue cross carrier paying all lines on one family member then on the other denying the admin code as redundant. it's not the modifier that is causing the problem it is something specific to this particular carrier. I bill for Peds and I only have a handful of insurances that require the 25 modifer on the well visit with immunizations the bulk of my claims go out the door without using any modifiers on the claim at all

 

[vhammons]

Thanks for your help. Is this a new rule? I know last year, our NP was getting paid for admin fees with preventative.