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Old 07-17-2012, 03:41 PM
Lynelle Lynelle is offline
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Exclamation Tdap and Administration

Help! I'm new to coding. Medicare is denying my patients the Tdap and administration fees. Which means $85 has to come out of my patient's pocket. What am I doing wrong here? Is there a correct way to code these so that they will pay? I've been coding 90471 immunization admin and 90715 for Tdap.

I also have a question regarding a patient the doctor saw as a home visit. Medicare has denied that visit. How should I code for that?

Thanks!
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Old 07-17-2012, 04:32 PM
britbrit852003 britbrit852003 is offline
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Medicare does not pay for this vaccine unless is was given for an injury. They consider it a self injectable (patient can get it at a pharmacy and do it themselves).
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Old 07-27-2012, 07:28 AM
RebeccaWoodward* RebeccaWoodward* is offline
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Quote:
Originally Posted by Lynelle View Post
Help! I'm new to coding. Medicare is denying my patients the Tdap and administration fees. Which means $85 has to come out of my patient's pocket. What am I doing wrong here? Is there a correct way to code these so that they will pay? I've been coding 90471 immunization admin and 90715 for Tdap.

I also have a question regarding a patient the doctor saw as a home visit. Medicare has denied that visit. How should I code for that?

Thanks!

90715 is not payable. 90718 is payable if there is documentation of an open would.

Jurisdiction 1 Part B

Are tetanus vaccines covered when treating a patient for an injury?

Answer:

Yes. Vaccinations or inoculations are a covered service when directly related to the treatment of an injury. Please note that if the tetanus vaccine contains other elements, such as diphtheria toxoids and/or acellular pertussis (commonly referred to as TD or TDAP), the claim will be denied. You can submit a redetermination request for payment of the tetanus portion of the vaccination with the following documentation:

Injury diagnosis
Signed office notes that include
The reason the injury would require the tetanus toxoid
Verification the injection was given
Location of the injection

There's only one problem. If you administered 90715, you can't file a corrected claim. The patient will be responsible. If you did sumbit the wrong CPT code, resubmit 90718 (assuming that's what the nurse did-confirm).

Resource: Internet-Only Manual, Publication 100-02 (PDF, 1.19 MB) (Medicare Benefit Manual), Chapter 15, Section 50.4.4.2, Immunizations
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Old 08-07-2012, 03:10 PM
pineapplelvr pineapplelvr is offline
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In MN , MC will not pay on the 90715 for us NOR can we bill it to the patient because it's an N status (we have provider based billing at the facility that i work at....ugh)

Medicare considers it to be part of other services
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Old 08-08-2012, 12:56 PM
Donna T Donna T is offline
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You didn't say how you billed your home visit or what the denial said but home visits are billed using codes 99341-99345 for a new patient or 99347-99350 for established patients and you have to be sure the place of service is a 12 for private residence. Hope that is helpful.
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Disclaimer: Although AAPC staff members will monitor these forums periodically, we cannot be responsible for the information posted herein, nor guarantee its accuracy. Our members may discuss various subjects related to medical coding, but none of the information should replace the independent judgment of a physician for any given health issue. Please note that the opinions expressed here do not necessarily reflect those of AAPC.

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