Wiki Tdap for Medicare

[smatt58]

Medicare does not cover a routine Tdap but if the patient was bitten by an animal would it be appropriate to submit
90715 + 96372 with an open wound diagnosis and nt adding Z23?
When I was in the office we would get and ABN and submit 90715 + 90471 with open wound diagnosis and Z23.
It was suggested to me by another coder that 90715 + 96372 should be used with diagnosis open wound only.
Thanks for the input.

 

[danskangel313]

If you look at the Medicare Benefit Policy 100-02 Chapter 50.4.4.2, it says
"Vaccinations or inoculations are excluded as immunizations unless they are directly related to the treatment of an injury or direct exposure to a disease or condition, such as anti-rabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin sera, or immune globulin."

You'd have to check with the MAC for your area as there may be an LCD; here's the one for our facility:
http://mediquant.com/policy/L34596_20151001.pdf

 

[CodingKing]

If they are there to treat a wound its not really an encounter for immunization so id leave the Z code off and use the S code for the wound

 

[lcathey@smsc.org]

AT Modifier

You may also need the AT modifier on the Tdap, the modifier is for Acute Treatment indicating it was from an injury.