Primary Care Coding Alert

Question: Medicare denies our claims for B12 injections. Do they only allow one unit, or are there changes we should know?

Arkansas Subscriber

Answer: Check your Medicare carrier's website and policies, because some (such as New Hampshire) will pay for one unit of B12 injections, but others (such as Oklahoma) don't cover B12 shots.

Possibilities: Medicare contractors that cover B12 injections usually apply very specific diagnoses to determine coverage. You might also need to include specific secondary diagnosis codes. Potential diagnoses include 261 (Nutritional marasmus), 263.0 (Malnutrition of moderate degree), 281.0-281.3 (for certain types of anemia), or 579.0-579.9 (Intestinal malabsorption). Medicare normally will not pay for B12 shots because of patient fatigue, dementia, or obesity.

Option: Most insurance companies pay minimal amounts for B12 vaccines. If your physician frequently administers the injections, you might consider asking patients to sign an Advance Beneficiary Notice (ABN) agreeing to cover the cost when you anticipate that a given administration will not meet your Medicare contractor's local coverage determination.