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SuperCoder Posted 6 Year(s) 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?

SuperCoder Posted 6 Year(s) 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]

Posted by SuperCoder, 6 Year(s). There are 2 posts. The latest reply is from SuperCoder.

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