Medical Billing Coding - Coding for wellness office visit and vaccines same day, cpt, codes
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Thread Topic: Coding for wellness office visit and vaccines same day
Topic Originator: Vanessa
Post Date June 13, 2016 @ 1:51 PM
Coding for wellness office visit and vaccines same day


Vanessa
June 13, 2016 @ 1:51 PM Reply  |  Email Friend   |  |Print  |  Top

I am having trouble with Indiana Medicaid paying for a wellness when billed with and office visit and vaccines. If I code for an office visit (OV) with vaccines I use mod -25 on the OV and my claim is paid. If a wellness is done same day I cannot get my wellness paid. It denies as incidental. Now I have found through trial and error that my Anthem Medicaid will pay the wellness if I code my OV with mod -59 and my first vaccine admin 90471 with mod -25. I should not have to code my admin with a mod and I should not have to use mod -59 but this payer prefers it. If I code the same way with my other payer MDWise Medicaid it denies both the wellness and OV as incidental but pays for my vaccine admin. For Indiana Medicaid to pay the wellness and vaccine admins are linked to a wellness DX (Z00.00 or Z00.129) and my OV is linked another DX that was addressed during the visit usually ADHD, Otitis Media, etc. Any suggestions are much appreciated!



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