Pediatric Coding Alert

These forms reveal legit multiple-IA billing methodsWhen faced with rejections for multiple shot administrations, try vaccine diagnoses, a one-line entry or a last-resort modifier."We have recently begun billing for +90472 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; each additional vaccine [single or combination vaccine/toxoid [list separately in addition to code for primary procedure])," writes Peg McCarthy, accounts receivable supervisor for Pediatric Health Association in Naperville, Ill. Payers are rejecting the code as duplicates.If the same problem plagues you, apply one of four techniques illustrated in this case study:At an 11-year-old established patient's preventive medicine service (99393, Periodic comprehensive preventive medicine reevaluation and management of an individual ... late childhood [age 5 through 11 years]; V20.2, Routine infant or child health check), a nurse administers three vaccines, which include:• Dtap -- 90715, Tetanus, diphtheria toxoids and acellular pertussis vaccine, when administered to individuals 7 years or older, for intramuscular use; V06.1, Need for prophylactic vaccination; diphtheria-tetanus-pertussis, combined (dtp) (Dtap)• MCV4 -- 90734, Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for intramuscular use; V03.89, Need for prophylactic vaccination and inoculation against bacterial diseases; other specified vaccination• a catch-up MMR -- 90707, Measles, mumps, and rubella virus vaccine (MMR), live, for subcutaneous use; V06.4, Need for prophylactic vaccination; measles-mumps-rubella (mmr).1. Match Your Product, Admin DiagnosesTo show insurers that each 90472 is for a different product, use the same ICD-9 code that you use with the vaccine product with the administration code, said Joel Bradley, MD, FAAP, in "Stop Losing CASH NOW: Beat the Challenges of Vaccines Coding Today" at The Coding Institute's Pediatric Coding and Reimbursement Conference 2007 in Naples, Fla. Using this technique, you would enter the above case study on a CMS form as follows:2. Switch to V20.2 for LimitationsYou may face restrictions, however, on how many diagnoses you can list. "Our system allows only two diagnoses," says Barbara Morgan in North Carolina. When she has several immunizations to report using 90472, she can't list all applicable ICD-9 codes.Solution: Although itemizing each diagnosis is optimal coding, lumping multiple 90472s under V20.2 is also OK, Bradley says. "You can use V20.2 for all vaccines given during a preventive medicine encounter."Using this strategy would change the above claim to read:Future: When your system restricts the number of diagnoses you can report, you're going to have to find a long-term remedy. If your billing system won't take more than one diagnosis, you need another vendor, says Nancy Reading RN, BS, CPC, CPC-I, vice president of educational services for the American Academy of Professional Coders in Salt Lake City.3. Use Units With 90472If line limitations cause your billing software to split a claim involving multiple 90472s, the insurer may receive [...]