# Code for No history of Chickenpox



## annielou (Nov 16, 2011)

I have a patient who is hesitant to receive the Zostavax vaccine.  she belives she may have never had the chicken pox.  We could draw a titre to see if she has, but Medicare will not pay for it.  Her secondary, which is through a retirement plan, said they would cover the titre if it was coded correctly.  How would you code for "No history of chickenpox(varicella)?


----------



## btadlock1 (Nov 16, 2011)

annielou said:


> I have a patient who is hesitant to receive the Zostavax vaccine.  she belives she may have never had the chicken pox.  We could draw a titre to see if she has, but Medicare will not pay for it.  Her secondary, which is through a retirement plan, said they would cover the titre if it was coded correctly.  How would you code for "No history of chickenpox(varicella)?



Well, you probably won't find a code that's exactly like that, but here are a couple of options:
I'd probably consider these first:
1. V72.61 - Antibody response examination
2. V73.89 Special Screening for other specified viral diseases

If those wouldn't work, look at these:
V71.89 Observation for other specified suspected conditions not found (if the test is negative) with maybe V02.9 - Carrier or Suspected carrier of other specified infectious organism as a secondary code, or as a primary code, if the test were to come back positive
V64.08 - vaccination not carried out because patient had the disease being vaccinated against

It may take a combination of codes to describe the situation, and it may still require an appeal - *Get an ABN*. I know the secondary said they'd pay if it's coded correctly, but just as soon as you trust that information, you'll get a denial from them stating that they don't cover expenses disallowed by Medicare, and you'll be stuck with lost revenue. If her plan is through a big payer (like BCBS/UHC/Aetna/etc.), try checking their clinical/medical policy bulletins on the titre to find the list of medically necessary covered indications for performing the test - they might have a list of covered diagnosis codes available there, and if not, they'll at least have specific enough terminology to point you in the right direction. (Ask provider services where to go, if you can't find the info). They can't tell you how to bill, but they can tell you what indications are covered for the services. Hope that helps!


----------



## annielou (Nov 16, 2011)

Thanks, we did get an ABN, but i am going to call her secondary tomorrow and give them the possible codes. Hopefully, they will pay.


----------



## mkm1517 (Nov 18, 2011)

Screening for elevated titer = V82.9 ??
(I know the definition is vague though - special screening of unspecified condition - but when you look up "screening - spell other - titer" this is the code that comes up.


----------



## us063958 (Nov 18, 2011)

*V05.4*

I would code V05.4 Need for other prophylactic vaccination and inoculation against singe diseases, Varicella


----------



## btadlock1 (Nov 18, 2011)

us063958 said:


> I would code V05.4 Need for other prophylactic vaccination and inoculation against singe diseases, Varicella



ICD-9 guidelines say that V05.4's for use when the purpose of the encounter is for the patient to receive the actual vaccine, so if they're just screening to see if it's possible, then it wouldn't be good to use that as a primary diagnosis. But, you could list it as a secondary or tertiary Dx, to provide more info on the test.


----------

