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Zostavax Administration

  1. Default Zostavax Administration
    Medical Coding Books
    What code are you using for the administration of Zostavax. This is the problem I am encountering:

    Medicare is not supposed to pay for the vaccine or the administration. Ususally you must bill Medicare 1st, receive the denial and then send to the secondary for the secondary to pay.

    Because there is not definitive code for the diagnosis, only generic V05.8, and you bill 90471, they will pay because that diagnosis code is an unspecified code and Medicare would never know you gave the Zostavax vaccine. There used to be a G code for part D administration of this vaccine, but either it is deleted now or I can not find.

    Help! What code to use for administration, CPT and DX?

  2. Default Zostavax
    We use the 90736 and 90471 for the admin of shot (if it's medicare use G0008)

  3. #3
    Default
    We use G0377 (Administration of vaccine for Part D drug) with diagnosis code
    V04.89 (need for prophylactic vaccination and inoculation against certain viral diseases–other).
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Question
    Quote Originally Posted by bpct6501 View Post
    We use G0377 (Administration of vaccine for Part D drug) with diagnosis code
    V04.89 (need for prophylactic vaccination and inoculation against certain viral diseases–other).
    Pam - when you use G0377 how does Medicare deny it? Are they denying as patient resonsibility or contractual obligation?
    Lisa Bledsoe, CPC, CPMA

  5. #5
    Default
    It looks like we bill G0377 and 90736 but they both actually get billed to the patient to submit to Part D. They can then turn over the payments to us. Since we don't necessarily get a copy of any EOB, I'm not sure what Part D pays on the administration, if anything. Sorry I don't know more than that.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
    Question
    Can that be done - not billing Medicare for denial first? Don't they need the Medicare denial to submit to their part D carrier?
    Lisa Bledsoe, CPC, CPMA

  7. #7
    Default
    I was following a patient's account that I had gotten questions on and they have posted her Medicare payment that she forwarded to us so they must pay without that denial. We have an internal policy that I was given where they inform the patient up front that they will be given the paperwork (bill) and they will be responsible for sending it to their Part D and then paying us. Seems to be working fine.
    Pam Tienter, CPC, COC, CPC-P, CCS-P, CPMA, CPC-I, AAPC Fellow
    AHIMA Approved ICD-10-CM/PCS Trainer
    AAPC National ICD-10-CM Trainer

  8. #8
    Location
    Greeley, Colorado
    Posts
    2,045
    Thumbs up
    AWESOME! I am going to implement that immediately! Thanks so much!
    Lisa Bledsoe, CPC, CPMA

  9. #9
    Default
    We use the NaviNet website to get Zostavaz paid by Medicare. It tells you if the patient has the coverage, how much they will pay and how much the patient needs to pay. It is pretty nice even though i havent got to use it since we set it up
    Herbie W Lorona Jr., CPC, CPC-H
    hlorona@up2parmedicalclinic.com

  10. Question Zostavax
    What code(s) should be used for the Medicare patient who is covered uner a Managed Medicare Plan? Do you still code 90736 and 90471 or (Gcode)? Or do you bill the patient directly for both services? Or are the carriers eligible to be billed?

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