Author Topic: billing 90471 and 90472  (Read 4970 times)

vbondar79

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billing 90471 and 90472
« on: February 14, 2012, 11:16:51 AM »
Billing Medicare. Patient came for administrative exam in addition flu shot was done. We billed medicare G0438, Q2036 and administration of vaccine two codes 90471 and 90472. Originally we got paid, but now medicare asking to return money for one administration code, and stating that we should bill only one of administrative codes. My biller is strongly disagree with this, because she states that 90471 and 90472 should be always billed together. Can you help us?

DMK

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Re: billing 90471 and 90472
« Reply #1 on: February 14, 2012, 11:20:20 AM »
Looking at your post, it only looks like 1 vaccine was administered (the flu shot) that would be 90471 only.  If there was a second administered vaccine then, yes you should bill 90472 as well. If not, then no.

vbondar79

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Re: billing 90471 and 90472
« Reply #2 on: February 14, 2012, 11:26:26 AM »
this what I understood from CPT book, but my biller thinks differently, she states these two codes like a combination, cannot be billed separetly. Moreover, it is not a first time she billed that way and we always got paid, only this one time they paid and now taking money back. By the way anyone know if there are any free medicare web site to ask them different questions about billing?

Michele

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Re: billing 90471 and 90472
« Reply #3 on: February 15, 2012, 09:08:13 AM »
By the way anyone know if there are any free medicare web site to ask them different questions about billing?

Not that I'm aware of.  :(
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DMK

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Re: billing 90471 and 90472
« Reply #4 on: February 15, 2012, 10:32:54 AM »
If you always got paid before, there must have always been another vaccine administered on the date of service.  Only the record would verify that.  This time, you only did one.

I'm going to go off on a tear right now......Just because that's how the biller has always done it, doesn't mean that it flies any more.  Things change in billing all the time.  Every year there are new things to do, and things that aren't allowed any more.  The biller needs to pick up the phone and approach it as if she made a mistake and needs to know the correct way to do it NOW.

I got chewed out yesterday because another office billed something one way, and I did it another way.  They were doing it the way they always did it (since the 80's) and I'm doing it up to standards as of 1/1/12.  And I'm the one getting chewed out!  (Ultimately she's costing her doctor lots of money........it makes my stomach sink to think how much she's cost him over the years.)

CYA and find out the RIGHT way to do it in 2012.  Never mind how they always did it before.  When Medicare starts sniffing around for their money back you need to fix what needs fixing!  JMO