V03.82

[LaceyShefstad]

Medicare does not accept V03.82 as a primary diagnosis. Is there another code I can use so this vaccination is covered? Patient came in primarily for this. In the assessment it says in need of health maintenance and is overall healthy.

 

[mitchellde]

V03.82 is an allowable first listed code. You need to check to see if it is covered for your patient, it may not be. There is no other code to use.

 

[LaceyShefstad]

Can you explain checking to see if it is covered for the patient?

 

[mitchellde]

It depends on your Medicare region. Check you LCD for coverage of pnemovax, do not auto assume it is covered. Medicare cannot deny the V03.82 just because it is first listed. The guidelines allow for this code to be first listed, so if it is denying them it must be for coverage.

 

[LaceyShefstad]

We are a rural health clinic and this was ran through the scrubber and it said the claim would be rejected with error stating when billing for influenza or pneumococcal vaccines, condition code A6, indicating Medicare payment is 100 percent, is required.

 

[mitchellde]

So Medicare did not reject the claim. You have an incorrect edit in your scrubber regarding V codes. Most V codes are allowed first listed, some are secondary only and some are first only allowed but the majority can be either first or secondary. You need to speak with the IT people for the scrubber to remove the edit.