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Tetanus inj with injury..........

  1. #1
    Default Tetanus inj with injury..........
    Medical Coding Books
    Will Medicare pay for a Tetanus injection even when its an injury? I have claims that are denied. Please and thank you!

  2. #2
    Default
    Yes they will pay if you are using a wound or burn dx to support the medical necessity....leave off the V code for prophylactic vaccination.
    Melissa Tescher, CPC, CPMA, CEMC Compliance and Coding Specialist
    Willamette Valley Professional Services member National Advisory Board 2013-2015

  3. #3
    Default
    I am getting the Tetanus denials even with the injury code. I wonder why? Is the a different modifier I should use? When I resubmit should I do anything different? Medicare is so difficult. LOL. Thank you for your reply!

  4. #4
    Default
    what code are you using for the tetanus? Make sure it is not a tDap or combo vaccine code. I think we use 90703 for just the tetanus injection long with the appropriate injury codes.

    This article may help:

    http://www.familydocs.org/files/CPCodingFAQs.pdf

  5. #5
    Default Tetanus
    Here in WA, Medicare does not cover Tetanus whether it's an accident or preventive. Fee schedule for medicare doesn't price the Tetanus vaccine codes.

  6. #6
    Location
    Columbia, MO
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    12,531
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    You need to use the V code for prophylactic use as that is the reason for the injection not the injury. Many insurances do bot cover this.

    Debra A. Mitchell, MSPH, CPC-H

  7. #7
    Location
    Grand Rapids, MI
    Posts
    230
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    I have had luck with researching this on my local contractors website. In MI mine is WPS Medicare. I can go to their website and type in my CPT in question and the LCD and NCD's pop up for me to read. These article will give you info on what dx's Medicare will pay on if the code is covered. Otherwise I would suggest sending in an appeal. Sometimes they need notes to see the medical necessity for these.

  8. #8
    Location
    Richmond Virginia
    Posts
    501
    Default
    Quote Originally Posted by mitchellde View Post
    You need to use the V code for prophylactic use as that is the reason for the injection not the injury. Many insurances do bot cover this.
    Debra, Even if the injection is given at the time of an injury you say it is still apropriate to apply the V code. Would'nt the V code be for routine purposes?

  9. #9
    Location
    Columbia, MO
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    12,531
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    A tetanus inject even when given at the time of an injury is still a prophylactic injection since the patient does not have tetanus. You are giving to injection to prevent the condition just as you do any other prophylactic injection. Such as hepatitis you do not give because they have it, you give to prevent it.

    Debra A. Mitchell, MSPH, CPC-H

  10. Default
    Per Medicare if injuries are involved they will pay for tetanus. you will bill the injury code first then the v code.

    You will bill 90471 90718 modifier 25 on E/m and modifier AT on the actual tetanus charge.

    Lesa

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