Wiki V64.05 - We recently went to a dinner

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amyrepp

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We recently went to a dinner put on by a vaccine company. If a caregiver refuses for an immunization to be administered, whether it was drawn up or due to other reasons, the speaker stated that we can bill the vaccine CPT code with this diagnosis to the insurance company. We bill $0.00. The speaker stated that by doing this the insurance company is notified that the physician attempted to administer the vaccine and it was refused. He stated that it will help with our HEDIS scores. Any thoughts on this?

Thank you,

Amy Repp
 
Caution...

:cool:

I would be careful with this one. Consider your source, a vaccine company. They may have their own motives. Maybe.

But, I wonder, if the whole thing about charging for drug waste (and the modifier) would apply here?

My first instinct was only an office visit should be billed with that ICD-9 code you gave. It is the ICD-9 code that tells the insurance company why the vaccine was not given, not the CPT.

Also, beware of coding to do anything else but provide proper coding. This includes things such as "getting paid" and "raising scores". If proper coding gets you there, great. But, do not code with the primary goal of these things.

If someone has a reputable source to go to for this (the vaccine question), I would like to know more, as well.

Thanks.
 
Give a Reason, Not a Procedure

We use this diagnosis code, and the others from this little category, everyday in my office. We frequently have parents that do not want their child vaccinated for various reasons and even after counselling, they still decide against it. We do not draw up vaccines until a parent has said yes to their child receiving a vaccine to prevent waste. I wish there were vaccine-specific diagnosis denial codes (maybe in ICD-10?), but for now we just code based on the reason. We also place this in the patient's problem list so the front desk knows not to schedule an appt for the vaccine without speaking to the parent who refused it.

We participate with our state's vaccine program and if we do not use these codes we will not pass our yearly audit with their automated software. This information is also passed along to our private payers in our quality reporting and helps raise our scores each year (check contracts for which codes trigger it).

My emr software will not allow me to send out a $0.00 procedure code. Will yours? I wonder if that vaccine rep actually ever sent out a claim!!! LOL!
Hope this helps a little. :D
 
If you cannot suit. 0 charge you are allowed to submit a penny charge as long as you adjust off the AR. Also V64 dx codes are secondary
 
V64 codes

The need for immunization should be specified with the V03-V06 codes followed by the V64 code that best describes the reason the child did not receive the immunization. Reporting of the CPT code for the vaccine that was not administered with a .00 charge does not provide further information at this time. ICD-10-CM will not include codes indicating need for immunization against specific diseases and so will offer less specificity for these scenarios. A refusal to vaccinate form should be maintained in the patient record when applicable.
 
Thank you all for your replies. I did talk to Michigan State Medical Society in regards to this code. They stated that there isn't a problem with submitting this diagnosis code to an insurance company. I was told that it actually helps the CDC when an office does so. I think that in the near future we wll be submitting more of these "diagnosis" codes for only reporting purposes.

Amy
 
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