Getting Denials with 90471, 90715 with patient-requested immunization no counseling.

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EricRmi

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Hi.

I need help getting paid when billing 90471, 90715 with patient-requested immunization, no counseling, Intramuscular, and only vaccine injected.

Patient went to the office requesting Tdap vaccination, as it has been more than 10 years since the last vaccination.

I get the same denial reason: "90471 denied for Missing/incomplete/invalid procedure code" every time.

I researched a lot due to this. The websites say the same sequence of coding; 90471 then 90715 which is what I am coding.


So please enlighten me. Thank you.
 
EricRmi said:
Hi.

I need help getting paid when billing 90471, 90715 with patient-requested immunization, no counseling, Intramuscular, and only vaccine injected.

Patient went to the office requesting Tdap vaccination, as it has been more than 10 years since the last vaccination.

I get the same denial reason: "90471 denied for Missing/incomplete/invalid procedure code" every time.

I researched a lot due to this. The websites say the same sequence of coding; 90471 then 90715 which is what I am coding.


So please enlighten me. Thank you.
Click to expand...


Your link from Noridian explains it pretty clearly. It is a non-covered item for Medicare Part B, unless there was an injury involved:

Copied and pasted from the Noridian link you shared:

The Medicare Part B program covers the tetanus vaccine (and other tetanus vaccine preparations that include diphtheria or pertussis components) is only covered as part of a therapeutic regimen of an injury. For example, if the beneficiary needs a tetanus vaccination that is related to an accidental puncture wound, the vaccination and administration would be covered under Part B. If the beneficiary needs a tetanus vaccine booster shot that is unrelated to an injury or illness, the vaccination and administration code will deny noncovered as there is no benefit category. The beneficiary may check with their Medicare Part D plan for possible coverage.



Edit to add: As the Noridian link also states, if the beneficiary has Medicare Part D (prescription drug coverage), they can check with their Part D plan.
 
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I should add that I am assuming that you're talking about a Medicare patient, since you shared the link from Noridian regarding Medicare coverage.

If the patient instead has commercial insurance, you'll have to find out if that patient's commercial plan covers it and what that coommercial payer's guidelines are for billing it.
 
Thank you for the quick responses.

The insurance is IEHP or Inland Empire Health Plan.

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Also, it's confusing since they put the specific reason for denial but the real reason is not actually covered..

So moving forward, should I not only focus on wrong codes but rather consider their reason for denial as part of non-coverage statements?
 
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