Terry Posted Mon 11th of June, 2018 14:40:20 PM
A patient was behind in his immunizations; the doctor billed for a DTaP. Empire Blue Cross/Blue Shield denied the claim: 90700, 90460, 90461, 90744, 90460, 90713, 90460, 90716, and 90460. The reason for the denial: CO7-The procedure/revenue code is inconsistent with the patient's age. After speaking with them and submitting an appeal, the claim was still denied. How do I bill for the DTaP for a 7-year-old who did not complete his 6-year-old immunization?
SuperCoder Answered Tue 12th of June, 2018 02:13:33 AM
CPT code 90700 should only be reported for patient younger than 7 years of age but at this time, your patient is a 7-year-old. This is the reason that payer has denied your claim.
You need to replace your CPT code 90700 (…younger than 7 years…) with 90715 (…7 years or older…).
Please feel free to write if you have any question.
Terry Posted Tue 12th of June, 2018 13:18:34 PM
I explained this to the doctor be she is adamant that I bill the 90700 because that is what was given to the patient. I also referenced the CDC DTaP given after the 7th birthday:
Children 7–10 years: DTaP may count as part of catch-up series. Routine Tdap dose at 11–12 may be given.
SuperCoder Answered Wed 13th of June, 2018 03:00:10 AM
As per CDC.gov, DTaP is not licensed for adolescents, adults, or children 7 years of age and older. But older people still need protection. A vaccine called Tdap is similar to DTaP.
DTaP is recommended for all infants and children younger than 7 years of age. Children age 7 years or older with an incomplete history of DTaP should be given Tdap as the first dose in the catch-up series. For these children, an additional adolescent Tdap may be given for the routinely recommended adolescent dose at age 11–12 years.
So you need to bill 90715 instead of 90700. If you still bill 90700, payers will deny this.
Please see links below to know more:
Please let us know for anything else.