Q&A: We?re getting denials for correct vaccine administration claims
APCs Insider, October 23, 2015
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Q: We are receiving denials for pneumococcal and influenza vaccine administrations due to an incorrect diagnosis code. We have followed what is in CMS Transmittal 3329 and can’t figure out what is incorrect and causing the denial.
A: If you reported ICD-10-CM code Z23 (encounter for immunization) on your claim, this is the correct code. However, there is an issue in the claims processing system for MACs that is incorrectly denying the claim. National Government Services (NGS) has published a Production Alert, but it could be affecting claims processing for other MACs as well.
The HCPCS and CPT® codes known to be included in the processing issue are:
- G0008—G0010; vaccine administration codes
- 90630, 90669, 90670, 90686, 90732, 90739, 90740, 90743, 90744, 90746, 90747; vaccine codes
NGS notes that it will make a mass adjustment to claims denied in error, so no appeal or claim resubmission is required by the provider. The time frame for this adjustment to be made is “soon,” according to NGS. If NGS is not your MAC, I recommend that you check your MAC website for the same notification. Monitoring the accurate processing of the ICD-10 codes is paramount to ensuring that mistakes are corrected and that reimbursement is correct.
Editor’s note: Denise Williams, RN, CPC-H, senior vice president of revenue integrity services at Revant Solutions, in Fort Lauderdale, Florida, answered this question.
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Related Products
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- Nursing responsibilities for managing pain
- Prevent dehydration with nursing interventions
- Note similarities and differences between HCPCS, CPT® codes
- The consequences of an incomplete medical record
- Steps for maintaining patient privacy
- Practice the six rights of medication administration
- Q&A: Primary, principal, and secondary diagnoses
- Skills of effective case managers
- Neurological checks for head injuries
- E-mailed
-
- The consequences of an incomplete medical record
- Q: Do patients need to renew HIPAA acknowledgements every year?
- Know the medical gas cylinder storage requirements
- Fetal non-stress tests represent important part of maternal and fetal health
- Does Your Agency Understand How To Respond to an ADR?
- Clinically Speaking: Accidental puncture laceration
- Clarifying status indicator ’S’ and ’T’ procedures
- Capturing start and stop times for infusions
- Searched
-
- coding productivity survey
- program managers job description
- Rothschild MD
- andrew rothschild
- business tips
- How many HCPCS codes are there
- BncH AND 1579 IN 40SELECT 40CHAR4011341CHAR4010741
- BncH AND 2007INVALID40CHR4011341CHR4010741CHR40113
- BncH AND 564240SELECT UPPER40XMLType40CHR406041CHR
- BncH AND EXTRACTVALUE407400CONCAT400x5c0x716b71627