Health Information Management

Q&A: We?re getting denials for correct vaccine administration claims

APCs Insider, October 23, 2015

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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.

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