Tetanus Shots and Workers Comp

It seems now when I bill a 90715, wc carriers are denying for incorrect code. Some have told be this is considered part of the exam and therefore bundled. Can anyone tell me if this is correct?

re: Tetanus Shots and Workers Comp

Not sure about it being included in the visit? I would not think it is because it would depend on the nature of the injury, if it were a sprain that would not require a tetanus vaccination.

Tetanus Vaccine
Issued: March 21, 2013
To report the tetanus vaccine administered for the treatment of an injury or direct exposure to a disease or condition, append modifier AT (acute treatment) to the code for the vaccine. Claims submitted without modifier AT will be denied.
Note: The medical record must support the need for the service and the use of modifier AT.
Vaccinations or inoculations are excluded as immunizations unless they are directly related to the treatment of an injury or direct exposure to a disease or condition, such as anti-rabies treatment, tetanus antitoxin or booster vaccine, botulin antitoxin, antivenin sera, or immune globulin. In the absence of injury or direct exposure, preventive immunization is not covered. However, pneumococcal, hepatitis B, and influenza virus vaccines are exceptions to this rule.
Reference: The Centers for Medicare and Medicaid Services Benefit Policy Manual, 100-02, Chapter 15, Section 50.4.4.2. *

re: Tetanus Shots and Workers Comp

Thank you for this information. I do not code claims, only bill them. Are you saying that something has changed in March this year on how this code must be billed? I must now use a modifier? When I bill this, it is always as a result of injury/exposure.
Did I misunderstand you? Thanks!

re: Tetanus Shots and Workers Comp

Well as of March of 2013 if the coder does not append this modifier then the claim will be denied.

re: Tetanus Shots and Workers Comp

Thank you. What modifier exactly must now be used please?

re: Tetanus Shots and Workers Comp

The modifer AT has to be used when they or you would charge for the vaccination administration ex-90471-AT( whoever does the charging). You could visit the CMS website for more information if you look at my original post it will tell you what you need to know.

re: Tetanus Shots and Workers Comp

This 90471 is for the administration which is included in the level. I am billing a 90715 for the actual vaccine. Any ideas?