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Tetanus j code?

  1. #1
    Location
    Melbourne, Florida
    Posts
    124
    Default Tetanus j code?
    Medical Coding Books
    For a medicare patient i billed 90718 and 90471 / vo6.5
    but it was denied as a co 96 non covered item...
    Is this a benefit that only covered once?
    Any feedback is appreciated.
    Thanks
    Denise Gilrane-Pillow, CPB

  2. #2
    Location
    North Carolina
    Posts
    3,126
    Default
    Tetanus is only covered when related to an injury

    Tetanus and Tetanus/Diphtheria Toxoids (90702, 90703, 90714, and 90718)
    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

  3. #3
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Quote Originally Posted by RebeccaWoodward* View Post
    Tetanus is only covered when related to an injury

    Tetanus and Tetanus/Diphtheria Toxoids (90702, 90703, 90714, and 90718)
    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
    Rebecca,

    When I reference the Medicare Manual, all it says is that vaccines (except for the flu, pneumonia, and Hep B vaccines) are only covered if administered for treatment of an injury or exposure to disease. Where does it say that the V code has to be first and an open wound code as secondary. Can you point me to your source for this info or is this a local carrier guidance?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Location
    North Carolina
    Posts
    3,126
    Default
    Hi Dawson,

    Below is my carriers reference to the "V" code.

    http://www.cignagovernmentservices.c.../cope4903.html

  5. #5
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

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