Pediatric Primary Care Coding Question

We have instances where a patient comes in for a well child check and ends up being sick. Also, they receive their immunizations at the visit. According to the insurance, there is a new CCI edit for modifier usage, as of 2014.

For example:
99391
90744
90670
90698
90680
90460 (x 4 units)
90461 (x 4 units)
99213 (-25 modifier)

However, this is how the claim was coded prior to this edit. According to the insurance, there should also be a modifier with procedure 99391 now. I am unable to find the correct modifier to use for this claim. The insurance will pay all line items EXCEPT the well child check (99391). Please help!!

Thank you!!

re: Pediatric Primary Care Coding Question

Use a modifier 25 on the well visit also.

re: Pediatric Primary Care Coding Question

Just out of curiosty, what DX are you using for the E&M 99213? Did the provider treat the patient for a significant and identifiable services outside of the vacccines and the Well child check?