Here is latest from a Healthcare plan in TN. Perhaps I am not seeming something, the healthplan is. Patient was seen for office visit, and as part of the visit received a flu shot as well as a therapeutic injection of Depo Medrol for another diagnosis.
Billed the following 99213 w/ modifier 25 for office visit, 90471 and 90658 for the flu shot, and 90772 and J1040 for the Depo shot.
The healthplan denied 90772 citing AMA/CPT guidelines, stating that the administration code was bundled with the 90471 code. Shots were given in different locations. I am inclined to appeal, however, I want to make sure I have not overlooked something.
The only reference I saw in CPT was that the admin codes were excluded under each other. I would like to appeal this case and make the healthplan accountable to the reference they cite.
Any other coding professionals have this come up? Am I on the right tract?
Thanks in advance.
Billed the following 99213 w/ modifier 25 for office visit, 90471 and 90658 for the flu shot, and 90772 and J1040 for the Depo shot.
The healthplan denied 90772 citing AMA/CPT guidelines, stating that the administration code was bundled with the 90471 code. Shots were given in different locations. I am inclined to appeal, however, I want to make sure I have not overlooked something.
The only reference I saw in CPT was that the admin codes were excluded under each other. I would like to appeal this case and make the healthplan accountable to the reference they cite.
Any other coding professionals have this come up? Am I on the right tract?
Thanks in advance.