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Old 04-30-2010, 08:36 PM
martyzal martyzal is offline
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Default 90718 Tetanus Toxid

I am trying to find the LCD list for Medicare on the 90718 code. I didn't think Medicare covered thid code but I was told if you had the appropriate dx due to the injury they would pay for it. However I could not find the LCD list on the fcso website. Could someone please send me the link.
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Old 05-02-2010, 05:51 AM
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aboncher aboncher is offline
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Default

This is not typically covered for preventive purposes. This link may be helpful.

http://www.wpsmedicare.com/part_b/po...94_alrg003.pdf
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Alaina M. Boncher, CPC
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Old 05-02-2010, 06:16 PM
mmallette mmallette is offline
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Default 90718 Td

I don't know where the list is but I do know you can code laceration and it will get paid. I must be an open wound not abrasion to be paid.
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Old 05-02-2010, 08:46 PM
KellyLR KellyLR is offline
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Smile 90718

I don't do vacs but I went for the challenge at CMS and this is what you can do:

I didn't know which state, carrier, etc. but look up CMS, Medicare Coverage, general Info, Medicare Coverage Database, Overview, then on left side of screen click Search and the dialog box will ask you for the CPT code. I looked it up under Trailblazer, for example, and found this dated and effective 1/1/2007:

Tetanus (90703, 90714, 90718) - These injections are covered when given for an acute injury to a person who is incompletely immunized.

When a tetanus booster is given to a patient in the absence of an injury, the injection does not meet the coverage criteria for Medicare (even though it may be appropriate preventive treatment).

Article Number: I-80A-R2 (A39821)

I hope this example will point you in the right direction

KellyLR
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Old 05-03-2010, 07:02 AM
jdibble jdibble is offline
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Default Need a Modifier

Our Medicare carrier, Highmark, will pay for medically necessary tetnus, however we have to append modifier AT to the drug and administration for it to pay, even with the dx of open wound. They will not pay for the charges for preventive reasons.

Jodi Dibble, CPC
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