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Dx code for tetatnus shot/routine vs. medical

  1. #1
    Default Dx code for tetatnus shot/routine vs. medical
    Clearnace Sale
    This may seem like a silly question, but I am getting a lot of denials for tetanus shots and the administration fees because of the laceration, cellulitis, burn code, etc. is attached. We get the insurance companies stating to file it with a routine code (V06.X). We file with the condition code since that is the reason the tetanus is updated on this visit, not because it was routine. Please let me know what you think!!

  2. #2
    For all of our patients needing tetanus, we code with the V06.x code indicating need for prophylaxis against...
    Anna Weaver, CPC, CPMA, CEMC
    Associate Auditor

  3. #3
    North Carolina
    Per CMS:

    When filing claims for 90702, 90703, 90714, or 90718, the primary diagnosis should be one of the ICD-9 "V" codes indicating the need for prophylactic vaccination against bacterial diseases or combinations of diseases (V03.7 Tetanus toxoid alone or V06.5 tetanus-diphtheria) plus an injury related ICD-9 code as the secondary diagnosis. Tetanus or tetanus-diphtheria toxoids adsorbed are only covered when directly related to the treatment of an injury/wound.

    Reference: Medicare Benefit Policy Manual (Pub 100-2, Chapter 15 Section
    Rebecca CPC, CPMA, CEMC

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  4. #4
    Thanks!!! I really appreciate it!

  5. #5
    Default Tetanus
    Thanks :-) Did you see the new coverage update for tetanus yet
    Heather Winters, CPC, CFPC

  6. Default
    Bad URL

  7. #7
    Default TDap
    I have had no success on filing a claim with Medicare and getting it paid for our TDap if its for vaccine or b/c of a wound. I use ONLY for Medicare patient and we do get payment from the Part D. Hope this could help Thanks

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