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  1. User id : 22576 Posted 2 years ago

    We are an Urgent Care facility with clinics across the US. We see many Medicare patients and treat open wounds, abbrasions, burns, etc.
    Medicare guidelines state the with a valid accident code the 90715 and other vaccines are covered. However, this code continually denies and has to be appealed. The 90718 is payable and we have no issues with it. The 90715 from my understanding should be paid without having to appeal every one. We are talking about hundreds of these procedures across the country every year. Is there any other codes or modifiers that can be added to get this code paid the first time?

  2. SuperCoder Posted 2 years ago

    Diphtheria, tetanus toxoid, and whole-cell or acellular pertussis vaccines:
    CPT codes covered if selection criteria are met:
    90471
    + 90472
    90700
    90701
    90715
    ICD-9 codes covered if selection criteria are met:
    V06.1 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis, combined [DTP] [DTaP]
    Other ICD-9 codes related to the :
    V03.5 Need for prophylactic vaccination and inoculation against bacterial diseases, diphtheria alone
    V03.6 Need for prophylactic vaccination and inoculation against bacterial diseases, pertussis alone
    V03.7 Need for prophylactic vaccination and inoculation against bacterial diseases, tetanus toxoid alone
    V06.5 Need for prophylactic vaccination and inoculation against combinations of diseases, tetanus-diphtheria [Td] [DT]
    Combination vaccination with diphtheria-tetanus-acellular pertussis, and inactivated polio (DTaP-IPV) (Kinrix™, GlaxoSmithKline):
    CPT codes covered if selection criteria are met:
    90471
    + 90472
    90696
    ICD-9 codes covered if selection criteria are met:
    V06.3 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis with poliomyelitis [DTP+polio]
    Combination vaccination with diphtheria-tetanus-acellular pertussis (DTaP), inactivated polio, and hepatitis B (Pediatrix®, GlaxoSmithKline):
    CPT codes covered if selection criteria are met:
    90471
    + 90472
    90723
    ICD-9 codes covered if selection criteria are met:
    V05.3 Need for prophylactic vaccination and inoculation against single diseases, viral hepatitis
    V06.3 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis with poliomyelitis [DTP+polio]
    Other ICD-9 codes related to the:
    V03.5 Need for prophylactic vaccination and inoculation against bacterial diseases, diphtheria alone
    V03.6 Need for prophylactic vaccination and inoculation against bacterial diseases, pertussis alone
    V03.7 Need for prophylactic vaccination and inoculation against bacterial diseases, tetanus toxoid alone
    V04.0 Need for prophylactic vaccination and inoculation against certain diseases, poliomyelitis
    V06.5 Need for prophylactic vaccination and inoculation against combinations of diseases, tetanus-diphtheria [Td] [DT]
    Combination vaccination with diphtheria-tetanus-whole-cell perussis (DTP) and haemophilis influenza type b (Hib) (TriHiBit™, Aventis Pasteur, Inc.):
    CPT codes covered if selection criteria are met:
    90471
    + 90472
    90720
    ICD-9 codes covered if selection criteria are met:
    V03.81 Need for prophylactic vaccination and inoculation against Hemophilus influenza, type B [Hib]
    V06.1 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis, combined [DTP] [DTaP]
    Immunization with DTaP, DTP, tetanus toxoid (TT), or tetanus and diphtheria toxoids (Td):
    CPT codes covered if selection criteria are met:
    90471
    + 90472
    90702
    90703
    90714
    90718
    ICD-9 codes covered if selection criteria are met:
    800.50 - 800.99 Fracture of vault of skull, open
    801.50 - 801.99 Fracture of base of skull, open
    802.1 Fracture of nasal bones, open
    802.30 - 802.39 Fracture of mandible, open
    803.50 - 803.99 Other and unqualified skull fractures, open
    804.50 - 804.99 Multiple fractures involving skull or face with other bones, open
    805.1, 805.3, 805.5, 805.7, 805.9, 806.10 - 806.19, 806.30 - 806.39, 806.5, 806.70 - 806.79 Fracture of vertebral column, open
    807.10 - 807.19, 807.3, 807.6 Fracture of rib(s), sternum, larynx, and trachea, open
    808.1, 808.3, 808.51 - 808.59 Fracture of pelvis, open
    809.1 Fracture of bones of trunk, open
    810.10 - 810.13, 811.10 - 811.19, 812.10 - 812.19, 812.30, 812.31, 812.50 - 812.59, 813.10 - 813.18, 813.30 - 813.33, 813.50 - 813.54, 813.90 - 813.93, 814.10 - 814.19, 815.10 - 815.19, 816.10 - 816.13, 817.1, 818.1, 819.1 Fracture of upper limb, open
    820.10 - 820.19, 820.30 - 820.32, 820.9, 821.10, 821.11, 821.30 - 821.39, 822.1, 823.10 - 823.12, 823.30 - 823.32, 823.90 - 823.92, 824.1, 824.3, 824.5, 824.7, 824.9, 825.1, 825.30 - 825.39, 826.1, 827.1, 828.1, 829.1 Fracture of lower limb
    830.1 Dislocation of jaw, open
    831.10 - 831.19, 832.10 - 832.19, 833.10 - 833.19, 834.10 - 834.12 Dislocation of upper limb, open
    835.10 - 835.13, 836.4, 836.60 - 836.69, 837.1, 838.1 Dislocation of lower limb
    839.10 - 839.18, 839.30, 839.31, 839.50 - 839.59 Dislocation of vertebra, open
    839.71 Dislocation of sternum, open
    851.10 - 851.19, 851.30 - 851.39, 851.50 - 851.59, 851.70 - 851.79, 851.90 - 851.99, 852.10 - 852.19, 852.30 - 852.39, 852.50 - 852.59, 853.10 - 853.19, 854.10 - 854.19 Intracranial injury, excluding those with skull fracture, open
    860.1, 860.3, 860.5, 861.10 - 861.13, 861.30 - 861.32, 862.1, 862.31 - 862.39, 862.9, 863.1, 863.30 - 863.39, 863.50 - 863.59, 863.90 - 863.99, 864.10 - 864.19, 865.10 - 865.19, 866.10 - 866.13, 867.1, 867.3, 867.5, 867.7, 867.9, 868.10 - 868.19, 869.1 Internal injury of thorax, abdomen, and pelvis, open
    870.0 - 897.7 Open wound
    910.0 - 919.9 Superficial injury
    940.0 - 949.5 Burns
    V03.7 Need for prophylactic vaccination and inoculation against bacterial disease, tetanus toxoid alone
    V06.1 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis, combined [DTP] [DTaP]
    Combination vaccination with diphtheria-tetanus toxoids-acellular pertussis, inactivated poliovirus and Haemophilis influenza type b (DTaP-Hib-IPV) (Pentacel®, Sanofi Pasteur, Inc.):
    CPT codes covered if selection criteria are met:
    90471
    + 90472
    90698
    ICD-9 codes covered if selection criteria are met:
    V03.81 Need for prophylactic vaccination and inoculation against Hemophilus influenza, type B [Hib]
    V06.1 Need for prophylactic vaccination and inoculation against combinations of diseases, diphtheria-tetanus-pertussis, combined [DTP] [DTaP]

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  • Posted by 22576, 2 years ago. There are 2 posts. The latest reply is from .