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   RE: Vaccine Coding
 From: Mamatha Agrawal
 To: Member Forum
 Posted: 10-23-2017 20:04
 Message: Yes, you should be able to put modifier -25 on your visit and get paid for the 90715 TdaP (or the Td code) and get the 90471 and 90472 paid. Same on all other vaccines.

UHC and Tricare want the NDC # and units.

Medicare and Medicare Advantage will need to see G0008 and G0009 instead of 90471 and 90472 when billing for flu shot and pneumococcal.

Mamatha Agrawal, MD
Family Doctor CaryNC
Cary, NC
Live in Raleigh, NC
Solo since 2012
Practice Fusion and NueMD
Original Message:
Sent: 10-23-2017 12:56
From: Michael Safran
Subject: Vaccine Coding

Is anyone successfully billing 90471 / 72 for adults when they bill for a tetanus booster?
90460 / 61 are for patients under 18.

I realize Medicare will only pay for tetanus vaccination if coded with an injury / laceration / foreign body, etc.

Michael S. MD

Original Message:
Sent: 10-18-2017 14:13
From: Melissa Weakland
Subject: Vaccine Coding

Since we started doing this we get paid without push back and much more than when we didn't do separate Ag. Well worth it.

Since ICD-10 it's easier as all codes for all vaccines now the same- z23 I think.
Was it maybe something with the ICD10 coding, i.e. you used something other than z23?

Why oh why can't they just say?

What a silly game we are forced to play. I feel like my employed friends sometimes seem to forgot that everyone, all institutional medicine, is forced to play too. That just cause you aren't looking at it when you do your medicine, doesn't make it an ok system and that this game consumes tons of institutional healthcare dollars. Maybe it just feels too big and unwieldy. And billing staff, given that's their job, aren't going to speak up about how crazy it is.

I'm glad that we in IMPs, given we're trained as critically thinking docs, see and verbalized and speak up against the absurdity as we do have to deal with it daily. I personally write complaints to the WA insurance commissioner. Figure it only takes my time and when they get enough, at some point change will happen.

Ok- I fell into a rant...

Melissa Weakland, MD
Ballard Neighborhood Doctors
5416 Barnes Ave NW
Seattle, WA 98107
Phone: (206)-297-7678
Fax: (206)-297-5930

Original Message------

I recall getting reminded about the 90460 and 90461 codes for pediatric vaccines and I just did a Tdap and tried to bill 90460 (X1 ) and 90461 X2.  The insurance rejected the 90461 saying it wasn't "attached" to any vaccine.   I read the blurb in the AAFP journal about how to code for this, each antigen in a vaccine gets a separate administration code.

Did you get any kick-back from insurance companies and have to explain that each antigen is counted separately?   (Kick-back is a poor choice of words but the only word I can think of)

Is everyone getting paid for this?

Kathleen Saradarian, MD
Branchville, NJ

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