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vaccine

N

nc_coder

Expert
Messages
300
Location
Iron Station, NC
I have a physician the gave a Prevnar vaccine to a 17 year old with newly diagnosed juvenile diabetes. BCBS is denying this for pts age is inconsistent with the vaccine. Does anyone have any insight into how to get this paid?
 
nc_coder said:
I have a physician the gave a Prevnar vaccine to a 17 year old with newly diagnosed juvenile diabetes. BCBS is denying this for pts age is inconsistent with the vaccine. Does anyone have any insight into how to get this paid?
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Nc-coder, BCBS might be going by the manufacturer's administration recommendations. I think Prevnar 7 (90669) and 13 (90670) are typically given up to age 6. Which code did your physician use? Or was the 23 valent version (90732) given?

At any rate, your physician should write an appeal letter stating the medical necessity. Here's a handy link a CDC article which may help your appeal. http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-pcv.pdf

Best of Luck,
Jettman
 
Thank you

Jettman,
Thank you so much for your response. It was very helpful. I will be using your suggestions and the link you sent to do an appeal. Again, thank you for your help.
 
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