20160930 - Save Up to 43% on CPC Training | Learn More

AAPC - August DL Sale: 50% OFF
Results 1 to 8 of 8

Thread: Medicare Immunizations and Modifiers????

  1. #1

    Default Medicare Immunizations and Modifiers????

    AAPC: CPC Promo
    Here are my two questions/scenarios:
    1. Medicare patient receives Adacel (90715) with a diagnosis of medical necessity (direct exposure).
    2. Medicare patient receives Adacel with a preventive diagnosis.
    In situation 2. would the clinic be required to obtain an ABN? Also, If an ABN was not obtained, would the clinic be able to bill the patient?
    I have heard a lot of conflicting information regarding this. I spoke to a Medicare rep and she said that Adacel is a covered CPT code and that the reason it would be denied would be due to the diagnosis code, thus we would be responsible for obtaining the ABN prior to administering the shot.
    Please advise

  2. #2
    Join Date
    Apr 2007
    Location
    Greeley, Colorado
    Posts
    2,046

    Default

    I don't believe Adacel is a covered vaccine for Medicare even if there is an approved dx code (for Tetanus or Tetanus and Diptheria). Because Adacel (90715) includes acellular pertussis, I'm failry certain CMS does not pay for it...at least our carrier (Trailblazer) does not. They will only pay for 90703, 90714 or 90718 with an injury dx. As for the ABN, I don't believe it is necessary, but would check your carrier and the CMS websites for validation.
    Lisa Bledsoe, CPC, CPMA

  3. #3

    Default ABN & Medical Necessity

    If after review of your National Code Determination and Local Code Determination, the service is specified as "not medically necessary" then you must have a signed ABN in the patients chart in order to bill the patient. Otherwise, your practice would have to write off the charge as "not a covered benefit."

    Hope this is helpful
    Laura

  4. #4

    Default correct coding

    Hello,
    i am stumped because i have a patient that for her visit she was given a TD shot; and office coded it as 90700. Which was invalid for the person since she was over 7 shouldn't the correct code be 90715? I thought that the cpt code 90718 would in fact be used like for a person who got stuck with a rusty nail or something to that effect. thank you for your help.

  5. #5
    Join Date
    Apr 2007
    Posts
    15

    Default

    90715 and 90718 are not the same drug. Medicare should cover a 90718 Td if the patient has a wound. Otherwise, obtain an ABN. Medicare does not cover a 90715 Tdap, even if there is a wound. Again, obtain an ABN.

  6. #6
    Join Date
    Apr 2007
    Location
    Greeley, Colorado
    Posts
    2,046

    Default

    Here is the link to Trailblazers LCD. 90715 is not on the list as one of the tetanus codes approved. My understanding that it is not covered or approved is because it contains pertussis and costs more. According to the CDC pertussis is recommended for patients under 65.
    http://www.trailblazerhealth.com/Too...spx?DomainID=1
    Lisa Bledsoe, CPC, CPMA

  7. Default

    billing medicare for dtap 90715 what icd-9 should be used

  8. #8

    Default

    Medicare does not cover the dtap (90715) no matter what ICD 9 code is used. The pt needs to sign an ABN if you want to get paid for it.

Similar Threads

  1. immunizations and modifiers
    By rogerandpaula@mchsi.com in forum Modifiers
    Replies: 3
    Last Post: 01-13-2016, 05:28 AM
  2. Medicare Wellness G0439 billed with Immunizations
    By janellhoard in forum Medical Coding General Discussion
    Replies: 1
    Last Post: 11-19-2015, 11:16 AM
  3. TDAP Immunizations/Medicare
    By Dawn Ruiz in forum Family Practice
    Replies: 4
    Last Post: 09-20-2011, 08:27 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •  

Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?

Login

Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.