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Diagnosis for Routine Vaccinations

  1. #1
    Default Diagnosis for Routine Vaccinations
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    Hello!

    I recently came across an article that stated each vaccine and administration code done in conjunction with a routine well visit can be coded with only diagnosis code V20.2/V70.0 Typically, I use V20.2/V70.0 as the primary and V03-V06 as secondary. Does anyone have a problem with getting reimbursement using V20.2/V70.0 by itself with no secondary code?

    Thanks for your help.

  2. #2
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    Quote Originally Posted by medcode12 View Post
    Hello!

    I recently came across an article that stated each vaccine and administration code done in conjunction with a routine well visit can be coded with only diagnosis code V20.2/V70.0 Typically, I use V20.2/V70.0 as the primary and V03-V06 as secondary. Does anyone have a problem with getting reimbursement using V20.2/V70.0 by itself with no secondary code?

    Thanks for your help.
    No, they usually don't care about which one you use - payers tend to accept the routine V codes without any problems. What's really important, is how you sequence the pediatric admin codes (90460/90461). Every payer wants them listed a little bit differently (some grouped with the vaccine code, and other want them all lumped together on a single line for each code). Check with your payers individually for their protocol. Hope that helps!

  3. #3
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    I thought the vaccination ICD 9 codes are included in health maintenance
    (V7.0/V20.X).Should we code seperately? We code HM CPT code along with Vaccination codes and Administration codes.

    Thank you

  4. #4
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    I'm seeing that there are a few different ways which is why I am asking if anyone has a problem getting reimbursed for just using V20.2/V70.0.

    I usually code:

    99393 -V20.2
    90734 -V03.89
    90470 -V03.89

    ...and I have never had a problem getting reimbursed, however, I recently came across an article that gives an example to code as shown below:

    99393 -V20.2
    90734 -V20.2, V03.89
    90471 -V20.2, V03.89

    ...and another article shows:

    99393 -V20.2
    90734 -V20.2
    90471 -V20.2

    Using the V20.2 alone would be easiest, but just seeking other's advice/opinions.

    Thanks for responding!

  5. #5
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    Thanks, Brandi. The reimbursement for the 90460/90461 codes haven't been a problem for me except for one company, and that's BCBS Federal. Talk about a mess!

  6. #6
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    Quote Originally Posted by medcode12 View Post
    Thanks, Brandi. The reimbursement for the 90460/90461 codes haven't been a problem for me except for one company, and that's BCBS Federal. Talk about a mess!
    BCFD wants lumped admins (all blue plans should)

    As for the Dx coding, I think it's a matter of preference. The most accurate/informative way to code it is using the secondary diagnoses, but it's not necessary for payment. V20.2 should be good enough by itself.

    @kumeena: You are correct in thinking that V20.2 has immunizations included in the description. I think that the other V codes are primarily for patients coming in to get single vaccines, w/o a well check. Used as secondary diagnoses, they can identify which admin codes go with which vaccine codes, but as I mentioned just a second ago, it's not necessary.

    If you only want to put V20.2/V70.0 on the claim, then that's all you really have to use. Hope that helps!

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