VACCINE 90700

[mesafam6]

I have a provider who billed a 90700(C90.00, Z94.81, D47.2) vaccine for a patient who is 59 years old. We billed the claim to Blue Cross/Blue Shield. It got kicked back for age not appropriate. Does anyone know how to bypass this? Is this a clearinghouse issue? patient needed vaccines for her medical treatments. Please advise. thank you.

 

[sls314]

You can’t bypass the age edit. You have to bill the correct code for the adult vaccine.

Which vaccine did the patient actually receive?

97014 is Tetanus Diptheria (Td)
90715 is Tetanus Diptheria and Acellular Pertussis (Dtap)

 

[irened@pediatricareassociates.com]

We administered 90700 to an 8-year old who was under-immunized, but Horizon denied it for not being age appropriate. Is there any way this can be bypassed?

 

[csperoni]

We administered 90700 to an 8-year old who was under-immunized, but Horizon denied it for not being age appropriate. Is there any way this can be bypassed?

NOT a clinician, but my understanding is the recommendation for age 7+ (even with incomplete history of DTaP/under-immunized) should be given Tdap. If you truly gave DTaP, I would have the physician write a letter explaining the medical justification and appeal, but would not be surprised if denial is upheld. Or try using unlisted 90749 with comparison to 90700. Good luck!

 

[irened@pediatricareassociates.com]

Thank you for your reply. I will keep that in mind and pass the information along to my Nurse Manager.