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Wiki Medical reason for pneumonia vaccine

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bearybubba2008

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Kane, PA
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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!
 
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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.
 
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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.
 
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