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Code for No history of Chickenpox

  1. #1
    Location
    Bentonville, Arkansas
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    Default Code for No history of Chickenpox
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    I have a patient who is hesitant to receive the Zostavax vaccine. she belives she may have never had the chicken pox. We could draw a titre to see if she has, but Medicare will not pay for it. Her secondary, which is through a retirement plan, said they would cover the titre if it was coded correctly. How would you code for "No history of chickenpox(varicella)?

  2. #2
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    Quote Originally Posted by annielou View Post
    I have a patient who is hesitant to receive the Zostavax vaccine. she belives she may have never had the chicken pox. We could draw a titre to see if she has, but Medicare will not pay for it. Her secondary, which is through a retirement plan, said they would cover the titre if it was coded correctly. How would you code for "No history of chickenpox(varicella)?
    Well, you probably won't find a code that's exactly like that, but here are a couple of options:
    I'd probably consider these first:
    1. V72.61 - Antibody response examination
    2. V73.89 Special Screening for other specified viral diseases

    If those wouldn't work, look at these:
    V71.89 Observation for other specified suspected conditions not found (if the test is negative) with maybe V02.9 - Carrier or Suspected carrier of other specified infectious organism as a secondary code, or as a primary code, if the test were to come back positive
    V64.08 - vaccination not carried out because patient had the disease being vaccinated against

    It may take a combination of codes to describe the situation, and it may still require an appeal - Get an ABN. I know the secondary said they'd pay if it's coded correctly, but just as soon as you trust that information, you'll get a denial from them stating that they don't cover expenses disallowed by Medicare, and you'll be stuck with lost revenue. If her plan is through a big payer (like BCBS/UHC/Aetna/etc.), try checking their clinical/medical policy bulletins on the titre to find the list of medically necessary covered indications for performing the test - they might have a list of covered diagnosis codes available there, and if not, they'll at least have specific enough terminology to point you in the right direction. (Ask provider services where to go, if you can't find the info). They can't tell you how to bill, but they can tell you what indications are covered for the services. Hope that helps!

  3. #3
    Location
    Bentonville, Arkansas
    Posts
    56
    Default
    Thanks, we did get an ABN, but i am going to call her secondary tomorrow and give them the possible codes. Hopefully, they will pay.

  4. Default
    Screening for elevated titer = V82.9 ??
    (I know the definition is vague though - special screening of unspecified condition - but when you look up "screening - spell other - titer" this is the code that comes up.

  5. Default V05.4
    I would code V05.4 Need for other prophylactic vaccination and inoculation against singe diseases, Varicella

  6. #6
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    Quote Originally Posted by us063958 View Post
    I would code V05.4 Need for other prophylactic vaccination and inoculation against singe diseases, Varicella
    ICD-9 guidelines say that V05.4's for use when the purpose of the encounter is for the patient to receive the actual vaccine, so if they're just screening to see if it's possible, then it wouldn't be good to use that as a primary diagnosis. But, you could list it as a secondary or tertiary Dx, to provide more info on the test.

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