Wiki Post-Exposure Rabies

[Jwinant]

If a patient has an open bite from a raccoon on their left index finger and comes to a county health dept clinic or ER/UCC first and then are referred to the health dept for post-ex to rabies vaccines, how exactly would each of the visits be coded? I found that when the nurses code the visit they only list Z23 for post-exposure and we are getting a lot of denials or paid 1/3 what we billed for. After everyone researched what codes to use and in what order they all contradict one another. I was under the impression we code: primary- S code, 2nd- W code, 3rd- Z20.3, and 4th- Z29.14, at least for the first visit and then for the following visits we drop the S and W codes and only use Z20.3 and Z29.14.

-For post-exposure do we use Z23 at all?
-Do we need the S and W codes for the first visit or all visits on all CPT lines or just the vaccine and not admin?

CPT codes the nurses list are always 90471, 90472, 90375(first round of shots only), and 90675

 

[mosemanh]

I bill for a LHD. Normally a patient is seen by ER for immunoglobin and first dose post rabies, then they come to us for the remaining 3.
We use Z20.3 primary then the bite code (W code). For Medicare, they require an additional code of Z29.14. CPT is the 90675 and 90471 for admin.
We usually get full reimbursement. I have one that came back with a patient balance for 2 doses due to deductible. BCBS called me and suggested using the S code to bypass the deductible as the hospital used that and it counted as an emergency medication.

 

[hrgill2021]

I bill for a LHD. Normally a patient is seen by ER for immunoglobin and first dose post rabies, then they come to us for the remaining 3.
We use Z20.3 primary then the bite code (W code). For Medicare, they require an additional code of Z29.14. CPT is the 90675 and 90471 for admin.
We usually get full reimbursement. I have one that came back with a patient balance for 2 doses due to deductible. BCBS called me and suggested using the S code to bypass the deductible as the hospital used that and it counted as an emergency medication.

Is the Z29.14, for Medicare, only used when the patient receives rabies immune globulin and first post rabies dose at the health department? Z20.3, Z29.14, W code, 90675, and 90471.

Do you know if the Z29.14 also needs to be used for commercial insurance?

 

[mosemanh]

The additional code is what Medicare gave me to use when I called. Since using it, they pay our Post Rabies claims. I don't understand this because we aren't the facility administering the immunoglobin, but that was given to me directly from a Medicare rep. We are using that on ALL Medicare post-rabies and they only get the last 3 doses with us.

Z29.14 is not needed for commercial.