Wiki vaccine administration- Need help

Create Wiki
neha.bhatnagar

neha.bhatnagar

Networker
Messages
74
Location
Mumbai, Maharashtra
Best answers
0
Hi Friends,

Physician has administered three vaccinations to a patient.
We have billed this as follows:
Vaccine 1
90471
Vaccine 2
90472
Vaccine 3
90472

Insurance company has just paid for 90471 and 90472 and denied 90472 for third vaccine.
How to bill for this service?
How can we get paid for the third vaccination administration? Do we need to add any modifier to 90472?

Thanks & Regards,
Neha Bhatnagar CPC, CPC-H
 
Ironically, I am holding on a call regarding this right now. Even if you bill 90471 x # the payors software may deny as a duplicate. You will learn over time to recognize these payors and it usually takes an adjustment request but you will be paid. Sorry there is not an easier solution but you will be paid.
 
Correct coding would be to code:
90471
90472
90472 59
To start, the 90472 states, "each additional vaccine" and "list separately, next the CMS billing manual states that units of one unless the code is distributed as a quantity, and each is not a quantity, drugs come in quantities and timed services are a quantity of x minutes. So each additional vaccine must be separately listed with a 59 modifier. This is the correct and compliant way to code it, and the way to maximize your reimbursement.
Debra Mitchell, MSPH, CPC-H
 
Respectfully Disagree

mitchellde said:
Correct coding would be to code:
90471
90472
90472 59
To start, the 90472 states, "each additional vaccine" and "list separately, next the CMS billing manual states that units of one unless the code is distributed as a quantity, and each is not a quantity, drugs come in quantities and timed services are a quantity of x minutes. So each additional vaccine must be separately listed with a 59 modifier. This is the correct and compliant way to code it, and the way to maximize your reimbursement.
Debra Mitchell, MSPH, CPC-H
Click to expand...

Debra - I have to respectfully disagree with this. When CPT states "each additional vaccine...list separately in addition to..." it means just that. Each vaccine and it's administration are separately billable and do not require modifier -59. With 90472 being an add-on code, modifier 59 is not necessary or applicable. 90472 must be coded x# if more than one additional administration is coded, otherwise any additional will be denied as duplicate. Also, since we are talking about administrations and not drugs/biologicals, quantities (x#) are appropriate.
 
we code it exactly how Lisa describes to do so - always have - never have had an issue.
I agree with Lisa - you do not use the .59 modifier on the 90472 - that would be incorrect. the initial admin is 90471 - and 90472 for any others (x's however many more they have) - in this case 90472x2.
 
lmjd said:
Ironically, I am holding on a call regarding this right now. Even if you bill 90471 x # the payors software may deny as a duplicate. You will learn over time to recognize these payors and it usually takes an adjustment request but you will be paid. Sorry there is not an easier solution but you will be paid.
Click to expand...

90471 x# would be denied as a duplicate because you can only administer one first vaccine.

I agree with Lisa, we have always coded 90471 for the first vaccine and 90472 x # for each additional... in this case:

90471
90472 x 2
 
Yes! I was having a Senior Moment and they are getting more frequent!:confused:
I meant to say 90472 x# not 90471- Shady Acres here I come!
I also agree that it is incorrect to use a modifier on each additional administration.
 
I do realize that this is an old post, and I hate open a can of worms here, but I feel the need to chime in. CPT Assistant, November 2000 states that code 90472 is to be reported one time for each addtional vaccine administered. I agree that modifier 59 should also be used on each addtional 90472 code.
 
You must log in or register to reply here.
Top