Wiki 90471 vs. 96372 for Rabies vaccine

[arctickat2@alaskan.com]

Our patient came in post rabies exposure from a Lemur bite. She picked up the Rabavert (rabies vaccine) at the pharmacy and brought it in to be administered in our office. I billed the drug CPT with a charge of ZERO and billed 90471 for administration. The claim was denied for "routine vaccine not covered", even though it was billed with ICD-10 for exposure to rabies and animal bite. Per the insurance this was to be coded with 96372 as it was a "therapeutic" injection even though it was a vaccine. Everything I can find online still shows that even though it was post-exposure, all "vaccines" should still be billed with 90471. Is it appropriate to bill a vaccine with 96372 in this situation? Any thoughts??

 

[thomas7331]

The insurance company is incorrect about the coding, as they often are - the vaccine is not therapeutic, it is preventive, because the patient does not actually have rabies and the vaccine is given as a precaution, not as a treatment, so it would not be appropriately coded as 96372. I think in this situation I would probably appeal. This denial is saying that the vaccination is not covered under the patient's plan, not that it is coded incorrectly. The determination should be made by the insurance company as to whether or not the patient actually has a benefit for this service, which requires a review of the patient's plan documents.

All that said, payers have the right to set their own reimbursement rules, and if they tell you in writing that it should have been coded with 96372, then if all else fails, you can bill it that way since you have that to back you up if you were ever questioned.