Wiki Medical reason for pneumonia vaccine

[bearybubba2008]

I have an adult patient that received a pneumonia vaccine at the request of one of our doctors because the patient works in a nursing home. We billed 90732 and 90471 with the dx code V06.6.
The patient called his insurance and they told him that if we sent it in as a medical code that they would pay it. Patient has no history of pneumonia; his only reason for getting it was because he works in a nursing home.
I have no idea what a medical reason for this situation would be. I personally think that it was billed correctly. The patient's insurance does not pay for adult immunizations (including the flu vaccine!).
Any help would be appreciated.

Thanks!

 

[Pam Warren]

It was billed correctly. Unless there was a medical reason such as autoimmune status or other condition such as COPD for which acquiring pneumonia would be detrimental, then you code the V code for preventive administration. That doesn't appear to be the case here. He received the immunization to prevent him from acquiring Pneumonia from his job--not because he has a personal health risk.

 

[sroberts28]

Maybe exposure to communicable disease-specified type NEC V01.89?

 

[bvanlaan@hotmail.com]

Just as an FYI V06.6 is the Dx code for flu and pneumonia given at the same TOS. The Dx for just pneumonia is V03.82.