Guest guest Posted April 15, 2012 Report Share Posted April 15, 2012 I never have placed a 25 modifier when doing immunizations at the same time as a preventive exam. I would submit it without the mod first and if one denies, then resubmit and then you know from then on. But every BC/BS is different, so YMMV. Pratt I recently learned from a patient that BC/BS throws out either the preventive services (check-up) code or the immuniZation administration code, whichever is the greater $'s, when they are used together. I solved the problem by adding modifier 25 to the preventive services code, allowing both codes to be processed by their computer. Aren't these two codes intended to be used together without any modifiers? Will I cause more problems than fewer by adding mod 25 to the prev serv code routinely when I use the fax admin code in addition when I give vaccines? Thank you, Marc Tanenbaum, MD Atlanta -- Pratt Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2012 Report Share Posted April 15, 2012 depends on the insurance, call your provider rep for the specific insurance or follow one claim for shots + preventive from each of your insurers to see that they are not kicked outUnited in RI required the 25 modifier on the preventive for shots, BCBSRI does notI always stick it on for Cigna and Aetna and they have not kicked it out.but it is probably state specific.LynnTo: From: kpratt.1022@...Date: Sun, 15 Apr 2012 08:56:39 -0700Subject: Re: Need Coding Advice I never have placed a 25 modifier when doing immunizations at the same time as a preventive exam. I would submit it without the mod first and if one denies, then resubmit and then you know from then on. But every BC/BS is different, so YMMV. Pratt I recently learned from a patient that BC/BS throws out either the preventive services (check-up) code or the immuniZation administration code, whichever is the greater $'s, when they are used together. I solved the problem by adding modifier 25 to the preventive services code, allowing both codes to be processed by their computer. Aren't these two codes intended to be used together without any modifiers? Will I cause more problems than fewer by adding mod 25 to the prev serv code routinely when I use the fax admin code in addition when I give vaccines? Thank you, Marc Tanenbaum, MD Atlanta -- Pratt Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2012 Report Share Posted April 15, 2012 I just always use the 25 modifier, and it has never caused any problems. Seems easier than knowing who wants it and who doesn't.---Sharlene > > I recently learned from a patient that BC/BS throws out either the preventive services (check-up) code or the immuniZation administration code, whichever is the greater $'s, when they are used together. I solved the problem by adding modifier 25 to the preventive services code, allowing both codes to be processed by their computer. > > Aren't these two codes intended to be used together without any modifiers? Will I cause more problems than fewer by adding mod 25 to the prev serv code routinely when I use the fax admin code in addition when I give vaccines? > > Thank you, > > Marc Tanenbaum, MD > Atlanta > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 15, 2012 Report Share Posted April 15, 2012 OH GREAT!!! Another thick layer of added complexity that makes more junk for us to remember and do and more opportunity for the payers to refuse to pay and patients to get upset if we make a mistake! Just when you think it really couldn't get much worse...! Oh, how I wish I could afford to just throw in the towel...Sharlene > > > > I recently learned from a patient that BC/BS throws out either the > preventive services (check-up) code or the immuniZation administration code, > whichever is the greater $'s, when they are used together. I solved the > problem by adding modifier 25 to the preventive services code, allowing both > codes to be processed by their computer. > > > > Aren't these two codes intended to be used together without any modifiers? > Will I cause more problems than fewer by adding mod 25 to the prev serv code > routinely when I use the fax admin code in addition when I give vaccines? > > > > Thank you, > > > > Marc Tanenbaum, MD > > Atlanta > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 16, 2012 Report Share Posted April 16, 2012 Many of our insurances do not pay for the physical,even for children, if you do not put the 25 modifier on the E and M medicine charge. So that is an easy fix. ________________________________________ From: [ ] On Behalf Of Pratt [kpratt.1022@...] Sent: Sunday, April 15, 2012 9:56 AM To: Subject: Re: Need Coding Advice I never have placed a 25 modifier when doing immunizations at the same time as a preventive exam. I would submit it without the mod first and if one denies, then resubmit and then you know from then on. But every BC/BS is different, so YMMV. Pratt On Sun, Apr 15, 2012 at 8:20 AM, Dr. T > wrote: I recently learned from a patient that BC/BS throws out either the preventive services (check-up) code or the immuniZation administration code, whichever is the greater $'s, when they are used together. I solved the problem by adding modifier 25 to the preventive services code, allowing both codes to be processed by their computer. Aren't these two codes intended to be used together without any modifiers? Will I cause more problems than fewer by adding mod 25 to the prev serv code routinely when I use the fax admin code in addition when I give vaccines? Thank you, Marc Tanenbaum, MD Atlanta -- Pratt Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 18, 2012 Report Share Posted April 18, 2012 , What is ‘YMMV’? Thanks, Eads, MD Pinnacle Family Medicine Colorado Springs, CO www.PinnacleFamilyMedicine.com From: [mailto: ] On Behalf Of Pratt Sent: Sunday, April 15, 2012 9:57 AM To: Subject: Re: Need Coding Advice I never have placed a 25 modifier when doing immunizations at the same time as a preventive exam. I would submit it without the mod first and if one denies, then resubmit and then you know from then on. But every BC/BS is different, so YMMV. Pratt I recently learned from a patient that BC/BS throws out either the preventive services (check-up) code or the immuniZation administration code, whichever is the greater $'s, when they are used together. I solved the problem by adding modifier 25 to the preventive services code, allowing both codes to be processed by their computer. Aren't these two codes intended to be used together without any modifiers? Will I cause more problems than fewer by adding mod 25 to the prev serv code routinely when I use the fax admin code in addition when I give vaccines? Thank you, Marc Tanenbaum, MD Atlanta -- Pratt Quote Link to comment Share on other sites More sharing options...
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