coding synagis injection with GHI

ashleyg

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Our office is billing for synagis injections as the following

99213/25 dx-76517
90772 dx-76517
90378dx76517

are claims are being denied, as procedure code invalid for pt's age, although if we due bill with a vcode it will be considered a well child which it is clearly not, we have tried numerous times to appeal, and the original denial is upheld. any help on how other offices are billing this for GHI would be much appreciated!!!

Thank you
 

Lisa Bledsoe

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Greeley, Colorado
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What is the average age of the child receiving the synagis? I really think the primary dx code should be V04.82 followed by the prematurity status at birth. What kind of documentation do you have for the 99213/what is the specific reason for the office visit? If the visit is specifically for administration of synagis you shouldn't be coding an E/M.
 

EARREYGUE

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Loma Linda,CA
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I agree we bill with primary dx V04.82 and depending on the childs age the prematurity codes, I notice some insurance dont cover the prematurity codes since they are for newborns so we sometimes use V21.3* as history of prematurity as the secondary
 

dkerro33

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Synagis

DX codes we use when children come into office for synagis range from 765.21-765.29 or we use DX for certain condition they may have. We do normally code an E/m visit since child is seen by our doctor then synagis shot is given. We havent had any problems with payment that we are aware of.

Example:
99213 (25)
90772

Hope this helps

Donna K.
Mentor, Ohio
 

LOVE2CODE

Expert
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392
Location
Alexandria, VA
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What is the average age of the child receiving the synagis? I really think the primary dx code should be V04.82 followed by the prematurity status at birth. What kind of documentation do you have for the 99213/what is the specific reason for the office visit? If the visit is specifically for administration of synagis you shouldn't be coding an E/M.
I agree... This is the way I bill it......
 
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