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January, 2013

URGENT MESSAGE for AAP Members Provide and Bill for Vaccine Administration


On January 1, 2013 the Centers for Medicare and Medicaid Services (CMS) released the latest version of the National Correct Coding Initiative (NCCI) edits. The NCCI edits are code edits published by both Medicaid and Medicare to support correct coding and claims adjudication. Included in the new Medicaid and Medicare edits were edits on all evaluation and management (E/M) services that disallow patient with immunization administration codes without the proper modifier. The modifier indicator for all these edits is a "1," meaning that with proper modifier placement, the edit can be overridden.


While the Academy is urgently working with National Correct Coding Solutions - the CMS contractor for NCCI edits - to have the edits suspended on all preventive medicine service codes (99381-99385 and 99391-99395) with all immunization administration codes (90460 and 90461, 90471-90474). It should be noted that the edits are currently locked in and will continue to be in effect for Medicaid, Medicare, and private payers that implement CMS coding policies until such time that AAP advocacy efforts are successful. Over the past several days, the AAP has been in telephone contact with the highest levels of the CMS contractor responsible for the NCCI edits and has delivered a formal letter demanding retraction of these edits.


Therefore, effective immediately and for all claims submitted after January 1, 2013, AAP urges its members to append modifier 25 to the preventive medicine service code (99381-99395) when it is reported in conjunction with any immunization administration service (90460-90461; 90471-90474).


A modifier 25 should also be appended to other non-preventive medicine E/M services (eg, 99201-99215) when reported in conjunction with immunization administration -- but only when the E/M service is significant and separately identifiable.


We understand this is an administrative burden for you and your staff. The AAP is working diligently to unlock this change and will forward additional information on this issue as it becomes available.


Please contact the AAP Coding Hotline with any questions or issues: aapcodinghotline@aap.org


Thank you.


Medicaid Coding Notification 


National Correct Coding Initiative (NCCI) edit that does not permit payment of both a preventive medicine procedure code and a vaccine administration code on the same day of service.  Connecticut, along with other states, has been unable to persuade CMS and its contractor, Correct Coding Solutions (CCS), that these edits are inappropriate.  Their position is that providers must bill with modifier 25 (Significant, separately identifiable E/M service by the same physician...) on the second detail in order to bypass the edit whenever a preventive medicine code and vaccine administration code are billed on the same date of service.  While DSS questions whether this is an appropriate use of modifier 25, CMS and CCS advised us that this is the correct approach. 


DSS will continue to impress on CMS the need to reverse these edits.  In the meantime, providers should use modifier 25 on the second detail (and third detail if necessary) when billing for a preventive medicine code and vaccine administration code on the same date of service in order to bypass the NCCI edit.

Flu Vaccine Availability Increased 


The Connecticut Vaccine Program (CVP) is expanding the availability of influenza vaccine for the remainder of the flu season.  The program will now include all privately-insured children age 5 through 18 years old.  Influenza vaccine will be available through the CVP for all children 6 months through 18 years. 


To read the full letter from the Department of Health and see a list of flu formulations they currently have in stock click here.


If you have any questions please contact Mick Bolduc, Vaccine Coordinator for the Connecticut Vaccine Program at 860-509-7940 or michael.bolduc@ct.gov.


Dr. Lisa Menillo, St. Francis Hospital

Leading the charge to reduce lead poisoning   


Dr. Lisa Menillo, director of the Hartford Regional Lead Treatment Center and Healthy Homes Program at St. Francis Hospital and member of the CT American Academy of Pediatrics, is leading the charge to reduce the risks of lead poisoning among Connecticut families.


Lisa Menillo's career path took a decisive turn when, after finishing her residency in pediatrics, she was handed a simple piece of paper by Dr. Frederick "Skip" Berrien, the now retired director for the Child Abuse/Children's Advocacy Center at St. Francis Hospital in Hartford.


"He said 'there are all of these kids in the clinic with lead poisoning and no one to coordinate their care,'" she recalls. "He literally handed me a list of names and lead levels."

Menillo says she quickly realized that the medical aspect of lead poisoning is fairly simple, while the environmental part is not. Knowing she couldn't treat the problem without addressing both, she set out to create a team and a program... read more


Notes from Rwanda
Cliff O'Callahan, MD, PhD, FAAP


Happy New Year to my colleagues in the CT AAP!


I'm sorry I left you all for a year so soon after becoming the President Elect. OK. Truth be told, I'm not so sorry. This opportunity to spend a year in Rwanda being part of the biggest partnership and medical education transfer projects was just too good to pass up.... read more

Teleconference Participant Winner  


We held our first teleconference of the year on January 8th.  As part of our 2013 Series, we are now offering a special $10 Starbucks card as a thank you to one lucky participant.  Registrants need only complete the evaluation form at the conclusion of the program.  The winner from January's program is Anne Marie Benoit of Optimus HealthCare! 

At the conclusion of the series we will select one participant to receive a super special ipad 4G thank you gift.  Anyone who completes a evaluation form for any program will be considered for this gift. The more teleconferences you listen to and complete evaluations for, the better chance you have to win! 

Jillian Wood
Executive Director

Tracey McDougall
Teleconference Coordinator

Yvette Moretti
Administrative Assistant

Judy Blei
Government Relations

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