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Wiki Dx code for tetatnus shot/routine vs. medical

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karlam

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This may seem like a silly question, but I am getting a lot of denials for tetanus shots and the administration fees because of the laceration, cellulitis, burn code, etc. is attached. We get the insurance companies stating to file it with a routine code (V06.X). We file with the condition code since that is the reason the tetanus is updated on this visit, not because it was routine. Please let me know what you think!! :)
 
Per CMS:

When filing claims for 90702, 90703, 90714, or 90718, the primary diagnosis should be one of the ICD-9 "V" codes indicating the need for prophylactic vaccination against bacterial diseases or combinations of diseases (V03.7 Tetanus toxoid alone or V06.5 tetanus-diphtheria) plus an injury related ICD-9 code as the secondary diagnosis. Tetanus or tetanus-diphtheria toxoids adsorbed are only covered when directly related to the treatment of an injury/wound.

Reference: Medicare Benefit Policy Manual (Pub 100-2, Chapter 15 Section 50.4.4.2)
 
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