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Thread: Tdap and Administration

  1. #1
    Join Date
    Apr 2007
    Location
    Portland, Oregon
    Posts
    5

    Exclamation Tdap and Administration

    Help! I'm new to coding. Medicare is denying my patients the Tdap and administration fees. Which means $85 has to come out of my patient's pocket. What am I doing wrong here? Is there a correct way to code these so that they will pay? I've been coding 90471 immunization admin and 90715 for Tdap.

    I also have a question regarding a patient the doctor saw as a home visit. Medicare has denied that visit. How should I code for that?

    Thanks!

  2. #2
    Join Date
    Apr 2007
    Location
    Colorado Springs
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    174

    Default

    Medicare does not pay for this vaccine unless is was given for an injury. They consider it a self injectable (patient can get it at a pharmacy and do it themselves).
    Brittany Purcell, CPC

  3. #3
    Join Date
    Apr 2007
    Location
    North Carolina
    Posts
    3,127

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    Quote Originally Posted by Lynelle View Post
    Help! I'm new to coding. Medicare is denying my patients the Tdap and administration fees. Which means $85 has to come out of my patient's pocket. What am I doing wrong here? Is there a correct way to code these so that they will pay? I've been coding 90471 immunization admin and 90715 for Tdap.

    I also have a question regarding a patient the doctor saw as a home visit. Medicare has denied that visit. How should I code for that?

    Thanks!

    90715 is not payable. 90718 is payable if there is documentation of an open would.

    Jurisdiction 1 Part B

    Are tetanus vaccines covered when treating a patient for an injury?

    Answer:

    Yes. Vaccinations or inoculations are a covered service when directly related to the treatment of an injury. Please note that if the tetanus vaccine contains other elements, such as diphtheria toxoids and/or acellular pertussis (commonly referred to as TD or TDAP), the claim will be denied. You can submit a redetermination request for payment of the tetanus portion of the vaccination with the following documentation:

    Injury diagnosis
    Signed office notes that include
    The reason the injury would require the tetanus toxoid
    Verification the injection was given
    Location of the injection

    There's only one problem. If you administered 90715, you can't file a corrected claim. The patient will be responsible. If you did sumbit the wrong CPT code, resubmit 90718 (assuming that's what the nurse did-confirm).

    Resource: Internet-Only Manual, Publication 100-02 (PDF, 1.19 MB) (Medicare Benefit Manual), Chapter 15, Section 50.4.4.2, Immunizations

  4. #4
    Join Date
    Apr 2007
    Location
    Duluth
    Posts
    74

    Default

    In MN , MC will not pay on the 90715 for us NOR can we bill it to the patient because it's an N status (we have provider based billing at the facility that i work at....ugh)

    Medicare considers it to be part of other services

  5. #5

    Default

    2017 ICD-10-CM Coding Book
    You didn't say how you billed your home visit or what the denial said but home visits are billed using codes 99341-99345 for a new patient or 99347-99350 for established patients and you have to be sure the place of service is a 12 for private residence. Hope that is helpful.

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