Forum - Questions & Answers

Jun 26th, 2014 - padi1coder 10 

Medicare PT TDAP billing

our Medicare pt came in with a laceration of his hand, our Dr. administered a Tetnus. Medicare denied, the admin and inj stating: at least on Remark Code must be provided. Does Medicare not pay for TDAP at all regardless of coding?

99213-25 Dx: 88.20
90471 V06.1
90715 V06.1

Jun 26th, 2014 -

re: Medicare PT TDAP billing

V06.1 is for diphtheia-tetnaus and pertussis combined. if your only giving the tetnaus you should be using V03.7. Try that and resubmit as a corrected claim.

Jun 26th, 2014 - shanbull 51 

re: Medicare PT TDAP billing

Yes, tetanus vaccines are covered by Medicare when they are administered because of injury. The CPT® for just the tetanus vaccine is 90703 and the administration code is 970471 with the "medically necessary" injury diagnosis (the example from CMS on my info sheet has "complicated open wound on foot" and "puncture by nail" listed). My other info sheet says "Covered by Medicare Part B only for the following diagnoses:
870.0-897.7, Open wound, traumatic amputation; 910.00-919.9, Superficial injury; V03.7, Tetanus toxoid alone""

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