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coding synagis injection with GHI

  1. Default coding synagis injection with GHI
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    Our office is billing for synagis injections as the following

    99213/25 dx-76517
    90772 dx-76517
    90378dx76517

    are claims are being denied, as procedure code invalid for pt's age, although if we due bill with a vcode it will be considered a well child which it is clearly not, we have tried numerous times to appeal, and the original denial is upheld. any help on how other offices are billing this for GHI would be much appreciated!!!

    Thank you

  2. #2
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    What is the average age of the child receiving the synagis? I really think the primary dx code should be V04.82 followed by the prematurity status at birth. What kind of documentation do you have for the 99213/what is the specific reason for the office visit? If the visit is specifically for administration of synagis you shouldn't be coding an E/M.

  3. #3
    Red face
    I agree we bill with primary dx V04.82 and depending on the childs age the prematurity codes, I notice some insurance dont cover the prematurity codes since they are for newborns so we sometimes use V21.3* as history of prematurity as the secondary

  4. Default Synagis
    DX codes we use when children come into office for synagis range from 765.21-765.29 or we use DX for certain condition they may have. We do normally code an E/m visit since child is seen by our doctor then synagis shot is given. We havent had any problems with payment that we are aware of.

    Example:
    99213 (25)
    90772

    Hope this helps

    Donna K.
    Mentor, Ohio

  5. #5
    Smile
    Quote Originally Posted by Lisa Curtis View Post
    What is the average age of the child receiving the synagis? I really think the primary dx code should be V04.82 followed by the prematurity status at birth. What kind of documentation do you have for the 99213/what is the specific reason for the office visit? If the visit is specifically for administration of synagis you shouldn't be coding an E/M.
    I agree... This is the way I bill it......

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