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Question about coding for rabies vaccine administration

I have a pt. who had a bat in his room. No history of a bite and the bat was not captured and tested for rabies. The county health department said the pt. should receive rabies vaccine and immune globulin. The health department supplied the vaccine and the HRIG. What's the correct way to code for this? Since I did not purchase the vaccine and the HRIG, I can not bill for these materials as a procedure. If you put 90471-without a vaccine code, the ins. co. will not pay for the 90471. What about the correct E/M code? If I bill 99212 or 99213 with the diagnosis code V01.5 (exposure to a virus), they will not pay because I listed a sick procedure with a well "V" code.

Stuart Beeber, MD
Chappaqua Pediatrics

Question about coding for rabies vaccine administration

You should be able to bill the office visit with V04.5 (exposure to rabies)
and the admin code with a modifier (as it's not related to a well visit),
with the appropriate rabies vaccine diagnosis code. Or you could also bill
the product code and admin code, just enter a $0 charge for the product.
However, your best option might be to reach out to the medical director at
the insurance company and ask him/her what they would like you to do. Let me
know what company it is and I'll get you the name and number if you want to
go that route.

Susanne Madden
The Verden Group
Website: www.theverdengroup.com
Direct Line: 845-826-3330
Client Portal: https://theverdengroup.webexone.com

-----Original Message-----
From: hidden@email-address [mailto:hidden@email-address]
On Behalf Of Stuart E. Beeber
Sent: Friday, August 28, 2009 1:49 PM
To: hidden@email-address
Subject: [PedTalk] Question about coding for rabies vaccine administration

I have a pt. who had a bat in his room. No history of a bite and the bat
was not captured and tested for rabies. The county health department said
the pt. should receive rabies vaccine and immune globulin. The health
department supplied the vaccine and the HRIG. What's the correct way to
code for this? Since I did not purchase the vaccine and the HRIG, I can not
bill for these materials as a procedure. If you put 90471-without a vaccine
code, the ins. co. will not pay for the 90471. What about the correct E/M
code? If I bill 99212 or 99213 with the diagnosis code V01.5 (exposure to a
virus), they will not pay because I listed a sick procedure with a well "V"
code.

Stuart Beeber, MD
Chappaqua Pediatrics

Question about coding for rabies vaccine administration

P.S. The CPT code for the Rabies Immune Globulin is 96372.

Susanne Madden
The Verden Group
Website: www.theverdengroup.com
Direct Line: 845-826-3330
Client Portal: https://theverdengroup.webexone.com

-----Original Message-----
From: hidden@email-address [mailto:hidden@email-address]
On Behalf Of Stuart E. Beeber
Sent: Friday, August 28, 2009 1:49 PM
To: hidden@email-address
Subject: [PedTalk] Question about coding for rabies vaccine administration

I have a pt. who had a bat in his room. No history of a bite and the bat
was not captured and tested for rabies. The county health department said
the pt. should receive rabies vaccine and immune globulin. The health
department supplied the vaccine and the HRIG. What's the correct way to
code for this? Since I did not purchase the vaccine and the HRIG, I can not
bill for these materials as a procedure. If you put 90471-without a vaccine
code, the ins. co. will not pay for the 90471. What about the correct E/M
code? If I bill 99212 or 99213 with the diagnosis code V01.5 (exposure to a
virus), they will not pay because I listed a sick procedure with a well "V"
code.

Stuart Beeber, MD
Chappaqua Pediatrics