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admin code 90471/90472 - new rules

Just curious if offices have started billing with the new Immunization
Admin coding methods? Has any company *not* paid (I guess to early in the
year to really know).

But for those not already doing this, you should probably start - let the
companies try and deny the added charges, you have the RIGHT to bill this way!!

Single vaccine given:
line 1: 90471 ICD 1 (imm 1) Units: 1

2 Vaccines given:
line 1: 90471 ICD 1 (imm 1) Units: 1
line 2: 90472 ICD 2 (imm 2) Units: 1

3 Vaccines given:
line 1: 90471 ICD 1 (imm 1) Units: 1
line 2: 90472 ICD 2 (imm 2) ICD 3 (imm 3) Units: 2

4 Vaccines given:
line 1: 90471 ICD 1 (imm 1) Units: 1
line 2: 90472 ICD 2 (imm 2) ICD 3 (imm 3) ICD 4 (imm 4) Units: 3

So you are now able to bill with UNITS (multipliers) along with billing for
the *first* and *subsequent* injections.

Good luck, and may you take much more money from the insurance companies!!!!

Danny

***************************
Daniel Frieling mailto:hidden@email-address
Pediatric Software Intl., Inc. http://www.compukid.com
CompuKID, The Pediatric Toolkit
Computer software for primary care pediatrics
(800) WELL-CHILD (800-935-5244) Outside the USA: (973) 726-4444
***************************

admin code 90471/90472 - new rules

At 08:33 AM 01/12/2000 -0500, Daniel Frieling wrote:

>Just curious if offices have started billing with the new Immunization
>Admin coding methods? Has any company *not* paid (I guess to early in the
>year to really know).
>
>But for those not already doing this, you should probably start - let the
>companies try and deny the added charges, you have the RIGHT to bill this
way!!

Of course they'll try to deny the added charges, then leave it up to us to
spend the time and energy appealing. We also have the RIGHT to bill for
after-hours charges, telephone calls, pulmoaide supplies, lab specimen
collection & handling, and well & sick visits on the same day - a lot of
good that right does us once an insurance company has decided a CPT code is
a PPO write-off. Having the right to bill is kind of like the pedestrian
who says (as the driver is running the red light), "But I have the walk
sign and the RIGHT of way!"

-SNIP-

>4 Vaccines given:
>line 1: 90471 ICD 1 (imm 1) Units: 1
>line 2: 90472 ICD 2 (imm 2) ICD 3 (imm 3) ICD 4 (imm 4) Units: 3
>
>So you are now able to bill with UNITS (multipliers) along with billing for
>the *first* and *subsequent* injections.

I don't know if this would make a difference in how an insurance company
processes and pays for a claim, but I'm wondering if instead of using one
single line and two or more units for 90472, it might be clearer to bill on
multiple lines like this when 3 or more vaccines are given:

line 1: 90471 ICD (imm 1) Units:1
line 2: 90472 ICD (imm 2) Units:1
line 3: 90472 ICD (imm 3) Units:1
line 4: 90472 ICD (imm 4) Units:1

This way each line is linked to it's own ICD code for those who use the
"need for vaccine" rather than V20.2 (well child). I've also seen
insurance companies mess up enough times when multiple units are used for a
single code on a single line.

I hadn't poked my nose into the 2000 CPT book yet and hadn't seen the
change in vaccine administration coding that you wrote about. But we'll
certainly give it a try! Thanks for informing all of us.

Michael Sachs, M.D.
General Pediatrician

admin code 90471/90472 - new rules

Michael Sachs wrote:

> I don't know if this would make a difference in how an insurance company
> processes and pays for a claim, but I'm wondering if instead of using one
> single line and two or more units for 90472, it might be clearer to bill on
> multiple lines like this when 3 or more vaccines are given:
>
> line 1: 90471 ICD (imm 1) Units:1
> line 2: 90472 ICD (imm 2) Units:1
> line 3: 90472 ICD (imm 3) Units:1
> line 4: 90472 ICD (imm 4) Units:1
>
> This way each line is linked to it's own ICD code for those who use the
> "need for vaccine" rather than V20.2 (well child). I've also seen
> insurance companies mess up enough times when multiple units are used for a
> single code on a single line.

I highly recommend the above method. I've NEVER, ever gotten paid for
multiple units of anything. Each one on a separate line is the only way
it's ever worked for me in the past. I would only add that the following
variation might work even better:

> line 1: 90471 ICD (imm 1) Units:1
add: DTaP CPT code Units:1
> line 2: 90472 ICD (imm 2) Units:1
add: IPV CPT code Units:1
> line 3: 90472 ICD (imm 3) Units:1
add: HiB CPT code Units:1
> line 4: 90472 ICD (imm 4) Units:1

--
Have a Happy Millennial New Year------Gary M. on LI
Clinton 8/17/98 GJ-59: "depends on what the meaning of the word 'is' is"
Forbes2000:
http://208.241.241.35/ePrecinctRegistrationCenter.html?OID=60713

admin code 90471/90472 - new rules

>I highly recommend the above method. I've NEVER, ever gotten paid for
>multiple units of anything. Each one on a separate line is the only way
>it's ever worked for me in the past. I would only add that the following
>variation might work even better:
>
>> line 1: 90471 ICD (imm 1) Units:1
> add: DTaP CPT code Units:1
>> line 2: 90472 ICD (imm 2) Units:1
> add: IPV CPT code Units:1
>> line 3: 90472 ICD (imm 3) Units:1
> add: HiB CPT code Units:1
>> line 4: 90472 ICD (imm 4) Units:1
>

Did you mean to add the actual CPT for the imm itself (just trying to
figure out what you are adding)? My original post was only commenting on
the admin-fee, that is definitely in addition to billing the shot and the
visit on other lines.

Danny

***************************
Daniel Frieling mailto:hidden@email-address
Pediatric Software Intl., Inc. http://www.compukid.com
CompuKID, The Pediatric Toolkit
Computer software for primary care pediatrics
(800) WELL-CHILD (800-935-5244) Outside the USA: (973) 726-4444
***************************

admin code 90471/90472 - new rules

Daniel Frieling wrote:

> >> line 1: 90471 ICD (imm 1) Units:1
> > add: DTaP CPT code Units:1
> >> line 2: 90472 ICD (imm 2) Units:1
> > add: IPV CPT code Units:1
> >> line 3: 90472 ICD (imm 3) Units:1
> > add: HiB CPT code Units:1
> >> line 4: 90472 ICD (imm 4) Units:1
> >
>
> Did you mean to add the actual CPT for the imm itself (just trying to
> figure out what you are adding)?

Yes. Also I've found in the past that if I pair each administration code
with each vaccine, rather than 4 immunization codes followed by 4
administration codes, there's a higher success rate.

--
Have a Happy Millennial New Year------Gary M. on LI
Clinton 8/17/98 GJ-59: "depends on what the meaning of the word 'is' is"
Forbes2000:
http://208.241.241.35/ePrecinctRegistrationCenter.html?OID=60713

admin code 90471/90472 - new rules

I thought the codes were "for one vaccine given" and "for 2 or more vaccines".
I thought that to mean if you gave only one shot, use only 90471. If you gave
2 or more shots, use 90472 but use it ONCE. ie, no matter how many shots you
gave, you would use 90471 or 90472. Here in NC, we receive state purchased
vaccines and can only charge $13.72 for one or 27.44 for two or more.
g barden

Gary Mirkin wrote:

> Daniel Frieling wrote:
>
> > >> line 1: 90471 ICD (imm 1) Units:1
> > > add: DTaP CPT code Units:1
> > >> line 2: 90472 ICD (imm 2) Units:1
> > > add: IPV CPT code Units:1
> > >> line 3: 90472 ICD (imm 3) Units:1
> > > add: HiB CPT code Units:1
> > >> line 4: 90472 ICD (imm 4) Units:1
> > >
> >
> > Did you mean to add the actual CPT for the imm itself (just trying to
> > figure out what you are adding)?
>
> Yes. Also I've found in the past that if I pair each administration code
> with each vaccine, rather than 4 immunization codes followed by 4
> administration codes, there's a higher success rate.
>
> --

admin code 90471/90472 - new rules

>I thought the codes were "for one vaccine given" and "for 2 or more vaccines".
>I thought that to mean if you gave only one shot, use only 90471. If you gave
>2 or more shots, use 90472 but use it ONCE. ie, no matter how many shots you
>gave, you would use 90471 or 90472. Here in NC, we receive state purchased
>vaccines and can only charge $13.72 for one or 27.44 for two or more.

2000 CPT book says to use 90741 for 1st vaccine and 90742 for subsequent
vaccines. So new *proper* coding for multi-vaccines is to use both on the
same bill. Whether you use one or multiple 90742's is new to me - I'd sure
like to hear if others bill them on separate lines.

Danny

***************************
Daniel Frieling mailto:hidden@email-address
Pediatric Software Intl., Inc. http://www.compukid.com
CompuKID, The Pediatric Toolkit
Computer software for primary care pediatrics
(800) WELL-CHILD (800-935-5244) Outside the USA: (973) 726-4444
***************************

admin code 90471/90472 - new rules

>> >> line 1: 90471 ICD (imm 1) Units:1
>> > add: DTaP CPT code Units:1
>> >> line 2: 90472 ICD (imm 2) Units:1
>> > add: IPV CPT code Units:1
>> >> line 3: 90472 ICD (imm 3) Units:1
>> > add: HiB CPT code Units:1
>> >> line 4: 90472 ICD (imm 4) Units:1

General question to the list - would the above coding (if automatically
done by software) be a nuisance? With electronic claims I guess it doesn't
matter how many lines you use (Chip, is there a limit on that?), but on
paper, if you have 5 immunizations you would have 10 lines just for that,
plus the well exam ...

Our software is not a billing system, but we pass data to billing systems
and our programmers are concerned that users will not like this - but they
like the idea of assisting to get higher reimbursement. (sorry, don't mean
to be plugging us, just sharing why I have the curiosity).

Thanks,
Danny

***************************
Daniel Frieling mailto:hidden@email-address
Pediatric Software Intl., Inc. http://www.compukid.com
CompuKID, The Pediatric Toolkit
Computer software for primary care pediatrics
(800) WELL-CHILD (800-935-5244) Outside the USA: (973) 726-4444
***************************

admin code 90471/90472 - new rules

Message from Chip Hart chip@.missing-host-name.

> >> >> line 1: 90471 ICD (imm 1) Units:1
> >> > add: DTaP CPT code Units:1
> >> >> line 2: 90472 ICD (imm 2) Units:1
> >> > add: IPV CPT code Units:1
> >> >> line 3: 90472 ICD (imm 3) Units:1
> >> > add: HiB CPT code Units:1
> >> >> line 4: 90472 ICD (imm 4) Units:1
>
> General question to the list - would the above coding (if automatically
> done by software) be a nuisance?

I don't know why.

> With electronic claims I guess it doesn't
> matter how many lines you use (Chip, is there a limit on that?)

There sure is. The NSF v2.0 allows 99 codes...but most
insurance companies are still limited to receiving 6 codes (as
are many of the clearinghouses).

You read that correctly. The INSURANCE COMPANIES are the
problem.
--
Chip Hart * chip @ pcc.com
Physician's Computer Company * http://www.pcc.com/~chip
1 Main Street * Work:800-722-7708
Winooski, VT 05404 * Fax: 802-846-8178

admin code 90471/90472 - new rules

>line 1: 90471 ICD (imm 1) Units:1
>line 2: 90472 ICD (imm 2) Units:1
>line 3: 90472 ICD (imm 3) Units:1
>line 4: 90472 ICD (imm 4) Units:1
>
>This way each line is linked to it's own ICD code for those who use the
>"need for vaccine" rather than V20.2 (well child). I've also seen
>insurance companies mess up enough times when multiple units are used for a
>single code on a single line.

We have offices that have had V20.2 type billing refused. They MUST assess
the immunizations. A WELL assessment is not an immunization, but you knew
that :) - that is why we bill the *proper* assessment with the *proper*
CPT. No idea what they'll do w/individual line billing.

>I hadn't poked my nose into the 2000 CPT book yet and hadn't seen the
>change in vaccine administration coding that you wrote about. But we'll
>certainly give it a try! Thanks for informing all of us.

See page 360 (at least that's what I think this fax says).

Danny

***************************
Daniel Frieling mailto:hidden@email-address
Pediatric Software Intl., Inc. http://www.compukid.com
CompuKID, The Pediatric Toolkit
Computer software for primary care pediatrics
(800) WELL-CHILD (800-935-5244) Outside the USA: (973) 726-4444
***************************

admin code 90471/90472 - new rules

Spo far, upstate New York remains blissfully behind the times. I
still have to bill only for the vaccine, which includes the wholesale
cost of the vaccine plus the administration fee. David Tinkelman, MD

------------------ Reply Separator --------------------
Originally From: Daniel Frieling
Subject: Re: admin code 90471/90472 - new rules
Date: 01/13/2000 08:40am

>I highly recommend the above method. I've NEVER, ever gotten paid for
>multiple units of anything. Each one on a separate line is the only
way
>it's ever worked for me in the past. I would only add that the
following
>variation might work even better:
>
>> line 1: 90471 ICD (imm 1) Units:1
> add: DTaP CPT code Units:1
>> line 2: 90472 ICD (imm 2) Units:1
> add: IPV CPT code Units:1
>> line 3: 90472 ICD (imm 3) Units:1
> add: HiB CPT code Units:1
>> line 4: 90472 ICD (imm 4) Units:1
>

Did you mean to add the actual CPT for the imm itself (just trying to
figure out what you are adding)? My original post was only commenting
on
the admin-fee, that is definitely in addition to billing the shot and
the
visit on other lines.

Danny

***************************
Daniel Frieling mailto:hidden@email-address
Pediatric Software Intl., Inc. http://www.compukid.com
CompuKID, The Pediatric Toolkit
Computer software for primary care pediatrics
(800) WELL-CHILD (800-935-5244) Outside the USA: (973) 726-4444
***************************

----------------------------------------------------------------------
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group.

Admin questions: "hidden@email-address" or
"http://www.pcc.com/lists/"

admin code 90471/90472 - new rules

At 02:39 PM 01/12/2000 -0500, Daniel Frieling wrote:

>
>We have offices that have had V20.2 type billing refused. They MUST assess
>the immunizations. A WELL assessment is not an immunization, but you knew
>that :) - that is why we bill the *proper* assessment with the *proper*
>CPT. No idea what they'll do w/individual line billing.

>
>Danny

Some insurance companies demand we use V20.2 and deny vaccines if any other
code is used, others of course require the "need for vaccine" "V" codes and
deny V20.2 for vaccines because we've already used it for the well child
(99381-99394) code. One minor problem with the "need for vaccine" codes is
that a visit with four vaccines then needs a total of 5 codes (including
the V20.2 for the well visit CPT code). Since an HCFA form only has room
for 4 ICD codes, this makes it necessary to send the visit as two separate
claims, otherwise the fifth ICD code doesn't show up on the claim form.
Plus it's a little more of a PITA for the person doing the data entry (at
least with our billing program) to link each vaccine CPT code to a
different ICD code rather than just use the same ICD code (in this case
V20.2) for each separate CPT procedure on the claim.
Michael Sachs, M.D.
General Pediatrician

admin code 90471/90472 - new rules

In a message dated 01/14/00 7:25:00 AM Central Standard Time,
hidden@email-address writes:

> 2000 CPT book says to use 90741 for 1st vaccine and 90742 for subsequent
> vaccines. So new *proper* coding for multi-vaccines is to use both on the
> same bill. Whether you use one or multiple 90742's is new to me - I'd sure
> like to hear if others bill them on separate lines.
>

My understanding of the 2000 CPT rules is that 90742 is to be used for EACH
additional vaccine after the first. Thus if you give 3 injections, you code
90741 once and 90742 twice. Combination vaccines count as one vaccination.

Ken Setter MD
Tulsa, OK