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Tetanus Toxid & E & M Coding

  1. #1
    Default Tetanus Toxid & E & M Coding
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    If a patient comes into an urgent care for wound injury, how do you code the visit and the injection. We are coding E & M with 25 modifier, 90471 (administration) and 90718 and are getting denied from Medicare. Should I be using a different dx for the visit than I do for the other 2 codes?

  2. #2
    Location
    Columbia, MO
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    12,570
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    what dx code(s) are you using and how are you linking them.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Default Tetanus Toxid & E & M Coding
    I am using 830.0, 959.5, and V03.7 on all 3 procedures.

  4. #4
    Location
    Columbia, MO
    Posts
    12,570
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    you must unlink the 830.0 and the 959.5 from the tetanus injection and toxiod codes link only the V03.7. The tetanus injection is not given as therapeutic for the wound it is only for prophylactic measures.

    Debra A. Mitchell, MSPH, CPC-H

  5. #5
    Location
    North Carolina
    Posts
    3,126
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    My carrier has a policy for this:

    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 (Td) toxoids adsorbed are only covered when directly related to the treatment of an injury/wound. For further instructions, please visit the Centers for Medicare Medicaid Services website to view the Internet Only Manuals (IOM) – Medicare Benefit Policy Manual (Pub 100-2, Chapter 15, Section 50.4.4.2 - Immunizations)


    http://www.cms.gov/manuals/Downloads/bp102c15.pdf

  6. #6
    Location
    Daytona Beach, FL
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    746
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    Who is your Medicare carrier? I code for an Urgent Care, our Medicare carrier is Highmark and we would get denied for the tetnus also. I spoke with Medicare about this and was told we needed to add modifier AT to the tetnus and the injection. Since we added this modifier we always get paid by Medicare.

    I would check with you carrier to see if they require this modifier and also bill the charge with the tetnus toxoid V code as the PDX.

    Hope this helps.
    Jodi Dibble, CPC

  7. #7
    Location
    Grand island Nebraska
    Posts
    11
    Default What is modifier AT?
    I am not familiar with modifier AT?

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