Medicare admin questions

OK, I have an office that billed Medicare for a 99215, 90732, G0009, 90718sl, 90471. Both the 90718 (which should not have been state supplied in this case as the pt was 65) and the 90471 had dx code V065 and were denied by both medicare and aarp as PR49 (done in conj w/ routine exam) Thoughts? Advice?

Thank you!
Martha

Vaccines

On a Medicare patient G0009 and 90732 are appropriate for the pneumococcal vaccine and administration.
Medicare does not cover routine tetanus/DT so codes 90471 and 90718 would be non-covered (get an ABN).

Can you tell us the diagnoses for 99215?

And was everything linked correctly? We routinely get paid for the pneumovax using 90732/V03.82/G0009.

medicare admin

Yes, we got paid ok for the other codes. The Td is apparently not covered and we should have gotten an ABN, Thanks!

Medicare admin questions

Was this really a high level E/M or was it a preventive medicine service in disguise? What were the diagnosis codes?

I don't think Td is covered by Medicare as routine. The pneumococcal should be covered with diagnosis code V03.82 or V06.6 (the second when both that and influenza was given.)

You can download CMS's preventive medicine chart from this article:

http://www.codapedia.com/~article_112_.cfm