Wiki Underimmunization

MCogdill

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Doctor listed Z71.9 for dx code which was kicked back. Parents refused immunizations and doctor is charged for counseling for the visit. What is the correct code for primary dx?
 
Z71.9 is for 'unspecified counseling' which would indicate that there was no documentation about what the counseling was about. If the records shows that counseling was regarding immunizations, then Z71.89 - other specified counseling - would be more accurate. However, that may or may not resolve the problem - what CPT code was billed and what was the reason given for the rejection or denial of the claim? It's also quite possible that the insurance may just not cover this.
 
Z71.9 is for 'unspecified counseling' which would indicate that there was no documentation about what the counseling was about. If the records shows that counseling was regarding immunizations, then Z71.89 - other specified counseling - would be more accurate. However, that may or may not resolve the problem - what CPT code was billed and what was the reason given for the rejection or denial of the claim? It's also quite possible that the insurance may just not cover this.
Originally they used Z71.9 unspecified. It was a charged as a second OV with the well visit as the doctor was charging for immunization counseling. I believe the insurance denied for Z71.9 as inappropriate primary dx code
 
Originally they used Z71.9 unspecified. It was a charged as a second OV with the well visit as the doctor was charging for immunization counseling. I believe the insurance denied for Z71.9 as inappropriate primary dx code
An office visit code would be inappropriate as those are for problem-oriented visits and require a chief complaint so it would be no surprise to see that deny with Z71.9.

Preventive medicine counseling would be coded with the 99401-99404 range of codes, but those shouldn't be billed together with a well visit on the same date and would likely deny as bundled anyway because of the 'separate procedure' designation.

I haven't seen your provider's documentation, but counseling on the need for an immunization would be a normal part of a well visit, and wouldn't likely warrant a separate code or charge unless it involved an unusual amount of time for some reason. The provider shouldn't just charge extra because the patient decided against the vaccination. Patients are within their legal rights to refuse care - providers can't penalize them because of this.
 
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