Wiki Denial for 90471 when billed with 90746 and 86580

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tamieweddle

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Hello,

I am currently receiving denials from Select Health for the 90471 code even though it is billed with an immunization (90476) if 86580 is also on the claim. They are denying it for subset procedure disallow. Has anyone come across this and know anything about fixing it? I have just been receiving these denials from Select Health for the past couple of weeks. Thanks!
 
Hi, have you noticed the parenthetical note for the CPT code 90471? how about the code description for the CPT code 90476? They do contradict. That is why you keep getting a denial. 90476 is for oral use. 90471 is injection. I leave the proper code for you to review. If still don't get it let me know. Happy coding! 🙂
 
My bad, I said the correct vaccine in the title of this post but the wrong one in the body of it. I am actually inquiring about 90746 for HepB not 90476. Thank you for the response though :)
 
Is there any other procedure that has been done which is related to HepB? I don't get how the TB test has anything to do with the HepB. I know Medicare doesn't cover HepB vaccine unless the patient is at medium or high risk for Hepatitis B.
 
That's what makes it so weird. It is only Select Health that is denying these and there have been other vaccines billed with it and it's denying with those as well. This particular claim only has 90471, 90746 and 86580.
 
90746-Hep B vax, adult dosage, 3 dose schedule, IM
90471-Vax administration, one vaccine
86580-TB skin test (including the the injectate)

I like to list the full codes in case we're dealing with typos, as above.

I looked up the provider manual for Select Health. Are you the Primary Care Provider of record? They only cover TB tests thru the PCP. If it is obtained through any other provider, then you bill Medicaid fee-for-service for it. Other than that, I cannot see a problem in their manuals.

The full definition of the denial is: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

I think you need to call them. Also, there is a free training webinar coming up on October 8, which may include a Q&A period.

Are you using the correct dx code?
 
I used Z23 for the vaccinations and Z11.1 for the TB test. And yes, we are the PCP. We did call them and all they would say was that it was denied as subset procedure disallow. Thank you for your help, I think we are going to have to refer these to our provider rep.
 
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