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90715

  1. #1
    Default 90715
    Medical Coding Books
    my 90715's are getting denied for people over 18..what am i doing wrong.

  2. #2
    Location
    Columbia, MO
    Posts
    12,843
    Default
    what does the denial indicate? it is probably due to not covered.

    Debra A. Mitchell, MSPH, CPC-H

  3. #3
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Most insurances don't cover very many routine vaccinations for adults. I would check with the payer to see if this is a contract exclusion (in which case you can usually bill the patient). Each payer has different policies; and even different groups can purchase different benefits.

    On a personal note - I had my booster (Tdap) and didn't even expect the insurance to pay for it - but of course, I work for insurance so I should know my own benefits!

    If your EOB puts it to patient responsibility, it is probably non-covered and you can bill the patient; if, however, they put it to provider and want you to write it off, I would be calling them.

    Hope this helps,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

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