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Tdap and Administration

Lynelle

Guest
Messages
5
Location
Portland, Oregon
Best answers
0
Help! I'm new to coding. Medicare is denying my patients the Tdap and administration fees. Which means $85 has to come out of my patient's pocket. What am I doing wrong here? Is there a correct way to code these so that they will pay? I've been coding 90471 immunization admin and 90715 for Tdap.

I also have a question regarding a patient the doctor saw as a home visit. Medicare has denied that visit. How should I code for that? :confused:

Thanks!
 

RebeccaWoodward*

True Blue
Messages
3,126
Location
North Carolina
Best answers
0
Help! I'm new to coding. Medicare is denying my patients the Tdap and administration fees. Which means $85 has to come out of my patient's pocket. What am I doing wrong here? Is there a correct way to code these so that they will pay? I've been coding 90471 immunization admin and 90715 for Tdap.

I also have a question regarding a patient the doctor saw as a home visit. Medicare has denied that visit. How should I code for that? :confused:

Thanks!

90715 is not payable. 90718 is payable if there is documentation of an open would.

Jurisdiction 1 Part B

Are tetanus vaccines covered when treating a patient for an injury?

Answer:

Yes. Vaccinations or inoculations are a covered service when directly related to the treatment of an injury. Please note that if the tetanus vaccine contains other elements, such as diphtheria toxoids and/or acellular pertussis (commonly referred to as TD or TDAP), the claim will be denied. You can submit a redetermination request for payment of the tetanus portion of the vaccination with the following documentation:

Injury diagnosis
Signed office notes that include
The reason the injury would require the tetanus toxoid
Verification the injection was given
Location of the injection

There's only one problem. If you administered 90715, you can't file a corrected claim. The patient will be responsible. If you did sumbit the wrong CPT code, resubmit 90718 (assuming that's what the nurse did-confirm).

Resource: Internet-Only Manual, Publication 100-02 (PDF, 1.19 MB) (Medicare Benefit Manual), Chapter 15, Section 50.4.4.2, Immunizations
 

pineapplelvr

Networker
Messages
74
Location
Duluth
Best answers
0
In MN , MC will not pay on the 90715 for us NOR can we bill it to the patient because it's an N status (we have provider based billing at the facility that i work at....ugh)

Medicare considers it to be part of other services :(
 

Donna T

Guest
Messages
114
Best answers
0
You didn't say how you billed your home visit or what the denial said but home visits are billed using codes 99341-99345 for a new patient or 99347-99350 for established patients and you have to be sure the place of service is a 12 for private residence. Hope that is helpful.
 
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