Medical Billing Forum

Coding => Coding => Topic started by: Urgent Care on January 26, 2011, 09:27:12 AM

Title: Payable Medicare code for a comparable code of 90715,
Post by: Urgent Care on January 26, 2011, 09:27:12 AM
I have been looking for a comparable, billable, payable Medicare code that is equal to a 90715. We are an Urgent Care facility that treats abrasions, wounds etc. and
more often than not our patients require a TDAP injection. Since Medicare sees this as routine they will not pay it, but they will pay for a seperate Tetanus  90703 or a 90296 Diptheria. I need a payable code for the combination, Tetanus, Diphtheria toxiod and acellular pertussis?
Title: Re: Payable Medicare code for a comparable code of 90715,
Post by: tlewis on January 26, 2011, 10:29:53 AM
From what I can tell the only way it would be paid is with an exposer or injury code. Preventative immunizations are not covered. So I guess your options would be to have the patients sign an ABN and collect from them. If not you will have to eat the cost.
here is a link with more infor

http://www.trailblazerhealth.com/Tools/LCDs.aspx?DomainID=1
Title: Re: Payable Medicare code for a comparable code of 90715,
Post by: Urgent Care on January 26, 2011, 12:15:49 PM
That's the big problem. They do go in with an injury code are still denied as routine and have to be appealed. Gets to be a bit much when you multiply over 300 clinics across the country and having to bill and appeal every one. Being an Urgent Care we see hundreds of injury's where patients really need th TDAP.  ???
Title: Re: Payable Medicare code for a comparable code of 90715,
Post by: tlewis on January 26, 2011, 03:15:50 PM
B. Tetanus and Diphtheria toxoids (90702, 90714, 90718) - These injections are temporarily being covered when given for an acute injury to a person who is incompletely immunized. This is due to the limited availability of the Tetanus toxoid.
When the availability of tetanus toxoid increases we may rescind coverage of these codes.

this was all I could find. 90714 is for both teanus and diptheria toxiods so acellular pertussis is the smoking gun in this case. Doc's might have to decide if the pt truely need the acellular pertussis or not
http://146.123.140.205/MLNMattersArticles/downloads/MM4222.pdf