COVID vaccine questions

jpeace01

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Hello all,

I work in an Infectious Disease clinic and we are having patients coming in only to discuss the vaccine with the physician. No infectious processes are occurring. They only reason for the visit is to discuss. I originally billed out the Z71.89 for the dx with the appropriate E/M code but, it is now being denied by Medicare and that they do not cover counseling dx codes. All the research I have done leads me back to the same code.

Can anyone point me in the right direction on how to best code for these?

Thank you!
 

thomas7331

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I haven't seen your documentation, but as you've described it, this would be considered a preventive service if the patient has no complaint - i.e. no symptoms or disease or other concerns that require evaluation or treatment. It sounds like you've used the correct diagnosis code, but this wouldn't be coded with an office visit E/M code - CPT codes 99401-99404 would be more appropriate to represent this service. However, by law, Medicare only covers a certain range of specified preventive services, and to the best of my knowledge, counseling about vaccines is not one of those benefits under the Medicare program, so it's appropriate that Medicare would deny this. The patient does have the option to pay out of pocket if they elect to have services that are statutorily non-covered by Medicare.
 
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