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billing Prevnar-13 vaccine

William Ivan Posted Wed 22nd of October, 2014 12:44:56 PM

Could you explain how to bill for prevnar-13 vaccine (both to medicare and commercial carriers)

SuperCoder Answered Wed 22nd of October, 2014 13:44:04 PM

Thanks for your question. Prevnar 13 is a vaccine used to protect against 13 of the most common pneumococcal bacteria strains. The billing for this vaccine is fairly straightforward. If you are billing Medicare you would bill G0009; Administration of pneumococcal vaccine and 90670; Pneumococcal conjugate vaccine, 13 valent, for intramuscular use. For Commercial carriers you would bill 90670 and 90471; Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid).
The diagnosis coding would depend on whether the patient is there for only a well child visit or if they only came in for the vaccine alone. If the patient is presenting for a well child visit, you can use diagnosis code V20.2; Routine infant or child health check which includes: developmental testing of infant or child, health check for child over 28 days old, immunizations appropriate for age, and routine vision and hearing testing. If your patient presented to have the Prevar 13 vaccine only; you may use V03.82; Need for prophylactic vaccination and inoculation against streptococcus pneumoniae [pneumococcus]. If your patient received both a influenza and a pneumococcal vaccine at the same visit use V06.6; Need for prophylactic vaccination and inoculation against streptococcus pneumoniae and influenza. Hope this helps.

William Ivan Posted Thu 23rd of October, 2014 10:13:22 AM

no special modifiers are needed for this type of vaccine, correct?

SuperCoder Answered Thu 23rd of October, 2014 10:59:52 AM

You are correct.

SuperCoder Answered Thu 23rd of October, 2014 10:59:53 AM

You are correct.

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