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#32901
07/21/2011 12:08 PM
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Medicare has been rejecting my Td codes. Any suggestions on what ICD-9 to use for a routine Td booster?
Leslie
Hospital Employed Physician Who Misses The Old AC
"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "
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Leslie,
It is my impression that Medicare doesn't cover routine Td. They must have an abrasion or wound. (one patient joked that she was going to go out in her rose garden and do some trimming before her next appointment).
A quick search on my billing system shows a medicare patient's TD (90718 and 90471) was paid with abrasion code 913.0
...KenP
Internist (retired 2020)
Florida
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A patient told me she got something from Medicare encouraging routine immunizations, including infuenza, pneumovax and tetanus. Typical that they would tell patients they need these and then not pay us for them. Can't wait to hear about MU.
Leslie
Hospital Employed Physician Who Misses The Old AC
"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "
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Remember, " I am from the government and I am here to help you!"
Tom Young, DO
Internal Medicine Consultants, PC
Creston, Iowa
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Leslie, I've had the same issue with Medicare not covering tetanus for routine immunizations. I checked Medicare.gov and they only list Pneumovax, hep B, and influenza as covered routine immunizations.
Has anyone been getting denials for Pneumovax immunizations? I'm just curious since patients may get it at the hospital if they are hospitalized and I likely will not know this or the patient will not remember this. They then come in for their Wellness Visit and we give them the Pneumovax (since I'm assuming they've never had it) and then Medicare likely will not pay this. Just wondering if anyone has had this happen.
John Carstensen, MD
Carstensen Internal Medicine
Key West, FL
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Medicare says they'll pay for pneumovax once per lifetime unless the patient has particular high risk conditions. They also say that it can be paid for if you made reasonable effort to determine whether the patient had already received it. If you get a denial because the patient had already received it, sending an appeal with some evidence that you tried to determine the possibility of past pneumovax will usually be successful.
We usually call the Medicare IVR which tells us whether the patient is eligible for the vax. Even if they say no, the patient may still need it due to high risk conditions. Hope this helps.
Cory
Practice Manager
CARE FIRST LLC
New Mexico
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Leslie
Hospital Employed Physician Who Misses The Old AC
"It's a good thing for a doctor to have prematurely grey hair and itching piles. It makes him appear to know more than he does and gives him an expression of concern which the patient interprets as being on his behalf. "
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