Medicare and CPT code 90714

kaylaholden

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Hello!

We are getting a lot of denials for the CPT code 90714 from Medicare. We have tried every which way possible to have them cover the charges. IE: a patient comes in for a dog bite on left forearm. We code ICD 10/CPT as follows:

1. Puncture Wound: S51.832A
2. Dog Bite : W540XXA


1. E/M 99203-25 OR 99213-25
2. Tetanus- 90714
3. Immunization- 90471-59

If anyone can help me out and let me know how you get Medicare to cover this fee, I would greatly appreciate it!
Thanks
 

sarah8873

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Gardner, KS
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Medicare will not pay for this

I work on the facility side for hospital outpt. Medicare will rarely pay for this, but it would have to be in an ED setting with an open wound/laceration from something such as a metal object, cut from a metal fence, or rusty nail etc. They would pay for a rabies vaccine for a dog bite but not tetanus. They definitely will not pay for routine tetanus at all. Also, most mdcr insurers will want XU not 59 but several advantage plans are taking the 59 for now...
 

empann

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Hello!

We are getting a lot of denials for the CPT code 90714 from Medicare. We have tried every which way possible to have them cover the charges. IE: a patient comes in for a dog bite on left forearm. We code ICD 10/CPT as follows:

1. Puncture Wound: S51.832A
2. Dog Bite : W540XXA


1. E/M 99203-25 OR 99213-25
2. Tetanus- 90714
3. Immunization- 90471-59

If anyone can help me out and let me know how you get Medicare to cover this fee, I would greatly appreciate it!
Thanks

You have to add an AT modifier to both CPT 90714 and 90471, which indicates that the vaccine was given due to an injury. Modifier 59 needs to be removed. It has been my experience that that is the only way that Medicare pays the tetanus shot. The modifier 25 stays on the E/M level, providing the patient sees a physician. If it is only a nurse visit you can only code the vaccine and admin of vaccine, as you cannot add a mod 25 to a 99211. Hope this helps.

Michele Pannullo, CPC
 
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daedolos

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According to several websites, the AT modifier is strictly for chiropractic services. I've never personally used them so I have zero data points on this modifier.

Peace
@_*
https://www.myoptumhealthphysicalhe...mbursement Policies/0050_ModifierATPolicy.pdf

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf

And I stand corrected. Thanks, empann!

https://www.texmed.org/Template.aspx?id=26923

I wish CMS would've stated it as well.

https://med.noridianmedicare.com/we...nd-diphtheria-vaccinations-billing-guidelines
 
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