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99381, 99391

  1. #1
    Default 99381, 99391
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    Hi. I'm new to peds and just started entering in charges and dealing with the denials and claims that haven't been sent out or worked on in several months. Don't know much about peds, i'm learning quickly about the immunization codes which are confusing. We had a denial for 99381 for a dos it looks like it was already used so i'm guessing I need to change it to a 99391. Are we able to use 99391 more than once during the wcc visits before age 1?

  2. #2
    Short answer = yes. 99391 can be used multiple times throughout the first 12 months of life up to the baby's first BD. After their first BD, use 99392 up to the 5th BD; 99393 ages 5 - 11, etc.

  3. #3
    Thank you so much for the info! It would be nice if this place paid for OT this is going to take a long time to fix. I can't believe the claims that have not been sent out or not worked on back in july and august, even had one from last march never sent. Any more advice on peds billing is greatly appreciated thank you so much to my fellow coders. : )

  4. #4
    Ft. Worth, Texas
    Before you send the claim in for March of last year, check with the insurance company for how long you have to file a claim before it is denied for timely filing. Some insurance companies it is 90 days, others maybe 180 to one year. Also appeals can be denied for timely filing.

    For 99381 you can send in a corrected claim stating the wrong code was used in error.
    Also state you are changing the code from 99381 to 99391 so they know what change is being made.

    Last edited by Biller385; 02-10-2011 at 12:03 PM.

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