Many doctors meet many patients who are worried about shingles. It is an aching skin problem that is caused by the virus called Varicella-zoster virus. This virus also causes chickenpox. When the patient recovers from chickenpox, little particles of the virus stay in the blood and, after some time, cause shingles. Shingles is basically a painful rash on your skin. The pain can go from months to years; therefore, vaccination is very significant. For the vaccination against shingles, using the correct CPT codes is very important.
What Is Shingles?
It is a condition in which a painful rash and blisters filled with liquid appear. It causes burning on the skin and fever. Shingles are caused by the virus known as Varicella-Zoster Virus. This virus is also responsible for causing chickenpox.
When the patient got treated for chickenpox, the virus did not fully vanish. After some time, the remaining virus becomes active again and causes shingles. Shingles are usually common in people aged 50 or older.
Why Vaccination Is Important For Shingles?
Vaccination is very important because it protects from getting shingles. It also help from getting severe pain. It reduces the risk of the condition worsening. Zostavax is a vaccine which is used in the past, but now the most commonly used shingles vaccine is Shingrix.
What Are CPT Codes?
CPT (Current Procedural Terminology) are unique healthcare code. Healthcare providers used these codes to inform the insurance companies about the services provided to the patient.
For example:
If the pateint get vaccination for shingles. The doctor or medical biller used a unique code, which is sent to the insurance company. The insurance company sees that code, and then the doctor gets paid. If the CPT code is not used, the billing system will be slow and confusing.
Common CPT Codes For Shingles Vaccination:
The following are the two major CPT codes used for shingles vaccination:
Shingrix:
Shingrix is a common vaccine used for shingles. 2 doses of Shingrix are given. The second dose is given after 3 to 6 months. This vaccination is suitable for people aged 50. CPT code 90750 is used for Shingrix.
Important Points:
Important points about the 90750 code are:
- Describe each dose one by one.
- Do not pack with other services provided.
- Do not describe many units for a single dose.
Zostavax:
Zostavax is a live attenuated vaccination. It includes only one dose. Zostavax is less effective than Shingrix. CPT code 90736 is used for Zostavax.
Important Points:
- Important points about the 90736 code are:
- Describe only one dose.
- This involves vaccination and management.
- Do not mix with code 90750.
How CPT Codes Help in the Billing System?
CPT codes help in 3 different ways:
- It helps to verify which vaccination type is used. It clarifies whether Shingrix and Zostavax are used. It avoids difficulty and confusion.
- Using the right CPT code helps to decrease the chances of rejected claims. The billing process becomes faster. Using incorrect codes can reject the claims.
- It helps the medical institutions to keep actual records. Helps the clinics track which vaccination is given. It makes ease to check the patient records and manage the right documentation.
What Are The Correct And Incorrect Use Of CPT Codes?
Incorrect: |
Correct: |
| Describing two units for a single dose of Shingrix. | Describe only one unit per dose. Each dose is reported in one billing line. |
| Using CPT code 90750 for Zostavaz. | Use 90750 for Shingrix and 90736 for Zostavax. |
Why is Correct Coding Important?
Correct coding is very important because using incorrect codes results in:
- Rejected claims.
- Patients have to pay huge bills.
- Decrease in profit or income.
- Have to experience audits.
But using the correct codes can reduce all these issues and errors. That is why professional medical billing services are crucial for healthcare practices.
Book Our Medical Billing Services!
Let DocVaz Medical Billing simplify your revenue cycle. Our expert team specializes in accurate CPT coding, timely claim submission, denial management, and complete income cycle optimization. With our reliable medical billing services, you can lower the administrative stress, enhance the cash flow, and concentrate completely on patient care.
FAQ’s
What are the common mistakes to avoid while coding?
The common mistakes to avoid while coding include:
- Mixing codes of Shingrix and Zortavax.
- Packing up vaccination with other services.
- Not clarifying insurance coverage.
- Reporting multiple units.
Can we bill both doses of Shingrix?
Yes, you can bill both doses of Shingrix. Bill 90750 individually for each code.
For which age is vaccination for shingles suitable?
Shingles vaccination is suitable for people at the age of 50 or older.
What happens if the wrong code is used in the billing system?
Using the wrong codes can cause many issues, such as claims getting denied, huge bills, or reduced revenue.
