Medical Billing Coding - pneumococcal vaccine, cpt, codes
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Thread Topic: pneumococcal vaccine
Topic Originator: yumi
Post Date March 25, 2008 @ 9:04 PM
pneumococcal vaccine

March 25, 2008 @ 9:04 PM Reply  |  Email Friend   |  |Print  |  Top

This vaccine was give to Pt(47yeras male) who has long history of diabetes. However his insurance does not cover PREVENTIVE and denied
I belive beside V0382, if we add another ICD-9 which show this was a medically necesary to keep diabeteti condition in controllable.
Do you have any idea??  I believe this is not a preventive, rather
necessary precaucious step??? Hope you understand my English.

March 28, 2008 @ 3:25 PM Reply  |  Email Friend   |  |Print  |  Top

If his insurance company plan does not cover preventive then no matter what you add to the ICD-9 code they will not pay due to the CPT code for the injection.  Could you not try and offer the patient a discounted fee for the injection since his insurance will not cover the injection.

April 13, 2008 @ 4:24 PM Reply  |  Email Friend   |  |Print  |  Top

I do not have my books at home.  However, I use the "given for high risk" HCPCS modifier (I can't think of it right now, check your HCPCS) when it's appropriate, along w/ the V10._ _ series to add the medical necessity to the vaccine V code.  If that doesn't work, I send a letter signed by the dr. to help show necessity.  I can usually get them paid then.  Some companies simply will not pay.  I also send a copy of the letter sent to  the insurance company to the pt so they are aware of our attempts to get their insurance to pay.  If all else fails as non-covered, I waive the administration fee, no discount on the vaccine.  Sometimes, of course, there is no medically necessary reason.

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