Wiki 90471 is getting denied

[EricRmi]

Good Day.

I would like to know how to properly report codes for 90471 for immunization.

Patient went to outpatient office because of chest pain. It is then confirmed by the doctor that the chest pain is a contusion front wall of thorax.

Patient was given ibuprofen oral for the pain.

Patient requested to get a flu shot as well.

90471, 90661 Z23

So I reported these codes:
99213-25 S20.219A (established patient)
90471, 90661 Z23


Then I got this denial
CL# 0102403063
90471 denied Missing/incomplete/invalid procedure code

I'm very sure this is a valid code and this is a complete code. Not sure what is "missing" procedure since the procedure is the immunization which is a different reason for the reason for visit chest pain.

I need help clarifying this and how to report immunization intramuscular without counseling.

 

[hsumm817]

Is the insurance commercial or Medicare? If Medicare you would use the G0008 for the administration. That is the only thing I can think they would mean as invalid procedure code.

 

[EricRmi]

Is the insurance commercial or Medicare? If Medicare you would use the G0008 for the administration. That is the only thing I can think they would mean as invalid procedure code.

This is IEHP.


Thank you for that code.

How about Tdap immunization vaccine?

Same scenario: patient went in for a different reason then asked for a Tdap due to their wound.

90471, 90715 was denied. I read 3 articles here in AAPC, all of those say 90471 is for adult without counseling but it keeps getting denied by IEHP.

 

[TThivierge]

Eric
You could be getting the denial due to REASON pt got the contusion on his chest? Add incident dx code and location/place where patient got chest contusion see Y92 dx block. Then Z23 is ok but the dx Z23 is correct since linked to that only. Did nurse give injection or provider doc? Some claims want the CPT link to the correct provider.
I hope helped you
Lady T

 

[EricRmi]

Eric
You could be getting the denial due to REASON pt got the contusion on his chest? Add incident dx code and location/place where patient got chest contusion see Y92 dx block. Then Z23 is ok but the dx Z23 is correct since linked to that only. Did nurse give injection or provider doc? Some claims want the CPT link to the correct provider.
I hope helped you
Lady T

Thank you so much for your inputs.
The documentation is lacking for to report an incident dx code.

The provider is a physician assistant.

Upon reading the lay term from Codify, it just says "the provider". Not sure if that needs to be a licensed physician but thank you for telling me that as it appears that some insurance companies wants an actual doctor.


To Admins of the forum: requesting for thread closure. Thank you