tci Part B Insider - 2014 Issue 19

Reader Question: Determine When Flu Vaccine, E/M Are Both Payable

Question: I have been reporting the flu vaccine with E/M visits and other in-office procedures. I have been using modifier 25 with these E/M codes, but some private insurance companies have been denying them. I bill the E/M with modifier 25 code first and then the flu vaccine. Can you advise regarding what I’m doing incorrectly? Answer: According to Correct Coding Initiative (CCI) edits, E/M office or inpatient codes are bundled into the vaccine administration codes 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care...

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