Author Topic: ICD and CPT for 2014 flushot  (Read 2188 times)

pmcsaipan

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ICD and CPT for 2014 flushot
« on: October 15, 2013, 10:23:19 PM »
Hello everyone,

This is my first post on this forum.

I would like to know if anyone knows the correct ICD and CPT combination to bill Medicare for a flushot.

shanbull

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Re: ICD and CPT for 2014 flushot
« Reply #1 on: October 21, 2013, 03:50:25 PM »
It depends on which flu shot (which brand/method of vaccination) and patient's age. I don't know if there have been any big changes since last year, but this should help you a lot:
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/qr_immun_bill.pdf

Also please note that Medicare does separate the actual vaccine and the administration of the vaccine into two different CPT codes.
« Last Edit: October 21, 2013, 03:53:21 PM by shanbull »

pmcsaipan

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Re: ICD and CPT for 2014 flushot
« Reply #2 on: October 29, 2013, 07:19:51 PM »
Thank you for your reply.

I've viewed the link but to be honest, I do not know how I should bill Medicare.

We've been billing Medicare for the administration of the flushot and have been receiving the denial of CO-107: The related or qualifying claim/service was not identifies on this claim.

The CPT code billed was 90471 AQ with diagnosis V048.

When we billed for the exact procedure last year, it was paid by Medicare.

I am not too sure how I can use the information on the link to bill Medicare correctly. Our seasonal flu vaccines are given to us for free from our local hospital.

My guess would be as follows:

A 66 year old patient comes in only to be administered the flu shot.

G0008 $26.84 (This is Medicare's fee for 90471)
Diagnosis: V0481
90654-How do I include this in the claim? I believe this is for the cost of the vaccine. If it is, how do we bill for vaccines that are free.

Again, thank you so much for your reply and I hope I can get more information.

shanbull

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Re: ICD and CPT for 2014 flushot
« Reply #3 on: November 06, 2013, 10:21:38 AM »
In that case I would try billing the actual vaccine code with a charge of 1 cent and possibly a GY modifier indicating you don't expect it to be paid. You should call Medicare on this particular issue just to make sure they don't want it coded in a specific way. They are pretty picky about coding. Which CPT you use for the vaccine depends on the brand (brand name vaccines have the designated Q codes, if it's not one of those brands use one of the 9 codes that describes the appropriate method of vaccination and patient age).

pmcsaipan

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Re: ICD and CPT for 2014 flushot
« Reply #4 on: November 07, 2013, 06:51:46 PM »
Thank you Shanbull.

I tried a couple of transmissions for flushot.

1.) G0008 $26.84  ICD: V0481 denied by Medicare because vaccine code was not submitted.

2.) G0008 $26.84 ICD: V0481
     90654 $0.00 ICD: V0481

The claim for number 2 is still pending. If it does get denied, I will try your suggestion of adding a GY modifier and see if that works.

Again, thank you.

I will update once EOB is received.

pmcsaipan

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Re: ICD and CPT for 2014 flushot
« Reply #5 on: December 12, 2013, 05:43:53 PM »
Here's an update:

Billed Medicare for flushot:

CPT 90654 modifier: GY $0.01 V04.81
CPT G0008 no modifier $26.84 V04.81


CPT 90654 Modifier: GY-Denied for the following reason:

CO-4 COPY ENVIRONMENT: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. 
MA130 COPY ENVIRONMENT: Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information. 

CPT G0008-Denied for the following reason:

MA15 COPY ENVIRONMENT: Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported. 

CO-107 COPY ENVIRONMENT: Related or qualifying claim/service was not identified on this claim. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. 
MA15 COPY ENVIRONMENT: Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported. 



I am really not too sure how else to bill for the flushot.

If anyone can offer me a solution I would be so happy.