90471

OK...I have been doing billing for a long time - and this is embarassing to even ask, but my 90471 are being denied as included with another proc. - I had been writting them off but on a phone call to an ins co (it might have been Fallon, I was trying to reverse something else and the rep said "this will pay with a mod"
Does anyone know what he is talking about..??
On most claims, if i am submitting an E&M, I have other procedures, so I have a 25 on it already, so that is not the issue.
Help....
Sara

90471

They (payors) consider 90471 incidental to any other procedure charged and unless I have missed something the only way that I know to get it paid for is if it's billed alone.
The only thing that I can think he would be talking about would be a modifier 59 and I seriously doubt it would be correct to use it. It would really depend on the documentation.

Not paid?

that is vaccine administration! If they don't want to pay, ask the patients with that insurance to bring their own needle and nurse and you'll hand them the vial!

90471

OOPs! I posted to the wrong question. Sorry

90471

I do know that some payors want a 59 modifier on this when billed with a E & M code

90471

It's mostly BCBS of MA - is anyone in MA finding this to be true with the 59 mod...??

What a stupid rule

Commentary- preaching to the choir- What difference does it make if there is a modifier or not? Tell the computers that it should pay 90471 and 90472 any time they are linked to a vaccine code. Done- simple-no questions asked!

90471

Now your talking!!! Because really, you said it above, what are the options, the pt's start sticking themselves...?? ARG...I'm going to bring in my BCBS rep and offer THEM a flu shot and ask them how THEY would like it injected since they do not pay for it...HA...that would be nice...if only.... :)

90471

There is some commercial claims editing program, some claim checking program, that bundles 90471 into a preventive medicine service or E/M TOTALLY INAPPROPRIATELY. Sorry, didn't mean to shout. Sometimes, this can be circumvented by adding modifier 25 to the E/M.

I like signature doc's idea: ask the patient to bring their own syringe and nurse.