vaccine refusal coding

cubs01

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Hello. My employer wants me to enter the vaccine CPT code to submiut to the insurance company when the patient refuses the vaccine. She wants me to take the amount of the vaccine out so the it's going out as zero dollars. She is telling me this is the proper way to bill when the patient refuses the vaccine. Is this correct? Thank you.
 

OCD_coder

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I have searched my compliance books and cannot find a reason to do this. A refusal is just a refusal and documentation to the insurance company would seem to be putting yourself as a bit of a risk. I am very interested in seeing additional information from others on this issue.
 

pineapplelvr

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there is a ICD-9 V code for a dx stating that they refused (sorry I can;'t think of it off the top of my head) but there wouldnt' be any use for a CPT code for this :)

hope that helps
 

jettman

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V64.05 is for caregiver refusal; V64.06 is patient refusal. Since these are in ICD9, I wonder if they are reported somehow to the CDC.

Michelle, does your provider want you to remove the dollar amount from the vaccine product code or vaccine adminstration code? I would take the $$ from the admin code if I had to make that choice.

Taking it a step further, what happens when the product is drawn up and ready to go, then the parent refuses? Would it become wastage, but billable to insurance with the V code dx?
 

lburke31

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i believe in the ama's "coding for pediatrics" it states that if the vaccine has been drawn and is then refused you may bill the full amount with the v code describing refusal.i will double check and let you know on monday. ljb
 
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