Tina Posted Fri 28th of August, 2015 14:42:07 PM
We are starting to get denials for members who are 18 when billing code 90633. Is the cut off 18 or 18 and a day? At what age do we start billing 90632?
SuperCoder Answered Mon 31st of August, 2015 01:22:54 AM
You should use CPT 90632, if your patient ages 18 and older. if He/she under 18, use CPT 90633. For better clarification, read attached question-answer.
Question: One of our payers has denied the second shot of a hepatitis A vaccine as a duplicate and has asked us to correct the claim. How do I explain in my coding that the hepatitis A vaccine consists of two doses?
Answer: Whether you administer two or more doses of the hepatitis A vaccine depends on the patient's age. Code 90632 (Hepatitis A vaccine, adult dosage, for intramuscular use) is the single-dose vaccine for adults ages 18 and older. There are two codes for pediatric/adolescent Hepatitis A vaccines. Code 90633 (Hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use) is the two-dose administration for children or adolescents under age 18. Code 90634 (Hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for intramuscular use) is the corresponding three-dose administration.
When you report 90633, the payer knows you'll be administering two doses of the vaccine within a certain timeframe. Some payers specify a minimum of 181 days between doses; others require a year. Payers may have similar guidelines applicable to code 90634. Verify guidelines for the payer in question so your physician can provide the service according to those parameters. Then make sure the physician documents when a vaccine is the second or third dosage of the schedule, so the payer will know how to handle the claim appropriately.