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
-
Briefings on APCs
Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...
-
HIM Briefings
Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...
-
Briefings on Coding Compliance Strategies
Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...
-
Briefings on HIPAA
How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...
-
APCs Insider
This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...
Most Popular
- Articles
-
- Note similarities and differences between HCPCS, CPT® codes
- Don’t forget the three checks in medication administration
- Differentiate between types of wound debridement
- OB services: Coding inside and outside of the package
- Know guidelines and subtle differences in code descriptions for laceration repairs
- Practice the six rights of medication administration
- What is the difference between an IPA and a medical group?
- Complications from immobility by body system
- What does case-mix index mean to you?
- Neurological checks for head injuries
- E-mailed
-
- Report condition code 51 for nondiagnostic services unrelated to inpatient stay
- Sounds like you’re going to have to push a little more paper next survey
- What is the difference between an IPA and a medical group?
- Tip: Reporting vascular dementia in ICD-10-CM
- Safety Month showcase: Steps for when a worker is exposed to bloodborne pathogens
- Report anesthesia charge using revenue code 370 and no HCPCS
- Q/A: Understand requirements for separately reporting CBC with manual differential
- Note similarities and differences between HCPCS, CPT® codes
- Capturing start and stop times for infusions
- Searched