1. Teresa Crawley
   Posted 3 months ago #
   

   (90714), can anyone give me the correct CPT code to file on a Medicare patient with an injury/wound? Medicare denys 90714
   Thank you,

2. SuperCoder
   Posted 3 months ago #
   

   Medicare doesn't cover if not an Injury/Wound:
   Medicare does not currently pay for the T/D vaccine – they consider it preventive and it doesn’t happen to be one of the preventive services they cover, but covers only in the event of an injury. You need to make sure you bill a diagnosis with the vaccine that supports an injury .
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   How to get it Paid:
   File the claim with CPT 90714 with GA modifier by obtaining an advanced beneficiary notice (ABN) signed by the beneficiary. By getting the ABN signed by the patient and using GA modifier, you are allowing Medicare to review the claim, which may or may not be denied.
   If Medicare pays the claim, the GA modifier is irrelevant.
   If the claim is denied, the beneficiary will be fully and personally liable to pay you for the service, personally or through other insurance.

3. Teresa Crawley
   Posted 3 months ago #
   

   Thank you Sanjit, the problem is according to Medicare, we are filing the wrong CPT, 90714 is not recognized by Medicare even though injury related they are requesting another procedure code and I can't seem to get the right code. I appreciate the help.

4. SuperCoder
   Posted 3 months ago #
   

   I think you should bill the following:
   90703: Tetanus toxoid adsorbed, for intramuscular use

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