Question Tetanus shot given during prenatal visit

AliMontone

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OB/GYN is new to our office. The coder presented this scenario to me. The doctor saw a patient for a prenatal visit (commercial insurance) and gave the patient a tetanus shot. Is this inclusive to the prenatal visit, or should we be billing it separately as a 90715 with a pregnancy diagnosis? Thank you for any guidance!
 

thomas7331

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OB/GYN is new to our office. The coder presented this scenario to me. The doctor saw a patient for a prenatal visit (commercial insurance) and gave the patient a tetanus shot. Is this inclusive to the prenatal visit, or should we be billing it separately as a 90715 with a pregnancy diagnosis? Thank you for any guidance!
The vaccine and administration are not a normal component of a prenatal visit so can certainly be billed. 90715 is a Tdap, not just tetanus, so make sure you're selecting the correct code here, and also bill the correct administration code (e.g. 90471) to go with it.

As far as the diagnosis, you'd need to share the physician's documentation to be able to advise on this. Z23 is for a vaccine that's given solely as a preventive health service. If the tetanus is being given because of an injury or for other reasons related to pregnancy, then you would code accordingly.
 

OpenClaims

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I am having trouble finding information on the diagnosis guidelines, however I have always been advised to put whatever the provider documented as the diagnosis in addition to Z23. Yes, the 90715 and admin code would be reported separately.
OB/GYN is new to our office. The coder presented this scenario to me. The doctor saw a patient for a prenatal visit (commercial insurance) and gave the patient a tetanus shot. Is this inclusive to the prenatal visit, or should we be billing it separately as a 90715 with a pregnancy diagnosis? Thank you for any guidance!
 

AliMontone

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I am having trouble finding information on the diagnosis guidelines, however I have always been advised to put whatever the provider documented as the diagnosis in addition to Z23. Yes, the 90715 and admin code would be reported separately.
Thank you!
 

AliMontone

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The vaccine and administration are not a normal component of a prenatal visit so can certainly be billed. 90715 is a Tdap, not just tetanus, so make sure you're selecting the correct code here, and also bill the correct administration code (e.g. 90471) to go with it.

As far as the diagnosis, you'd need to share the physician's documentation to be able to advise on this. Z23 is for a vaccine that's given solely as a preventive health service. If the tetanus is being given because of an injury or for other reasons related to pregnancy, then you would code accordingly.
Thank you!
 
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