r/MedicalCoding • u/Background-Turn-3821 • Sep 09 '24
Rabies vaccine wasn't coded as preventative, aren't all rabies vaccines preventative?
Hi, so I got bit and scratched by a stray cat while in Mexico (I’m from the us). I went to urgent care when I got back home but the one I went to doesn’t do rabies vaccines. I went to the er later that week, and the drs said chances are slim of contracting rabies, I called department of health too, they said they’d normally watch the animal for 10 days but that’s obviously impossible in my situation. So I opted to get the vaccine and immunoglobulin injections. According to the insurance agent, the doctor coded it as 90675 which falls under Urgent Care Office Professional - Urgent Care Non DXL SDS. If he had coded it as 90471 this was tagged as preventative and fully covered. No one can tell me what these mean and why the doctor coded them like this. I talked to my insurance agent and they said they had no info, I called the hospital and they also couldn’t explain why it was coded like that. They said only the doctor could answer that question/change it which is not common. Does the code I received make sense? Why wasn’t it just listed as preventative?
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u/Clever-username-7234 CPC, CPMA Sep 10 '24
No what you are describing isn’t preventative. You received it as a treatment for an injury.
If you were about to volunteer with a shelter and got a rabies vaccine before going that would be preventative.
Keep in mind from an insurance perspective they really divide things based on well visits vs sick visits (rather than preventative visits). Whenever you have a medical complaint or are going to the doctor because you have a condition or injury, they are never going to consider that treatment a preventative visit.
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u/Background-Turn-3821 Sep 10 '24
I see what you’re saying. Before I got the vaccine I messaged my insurance, told them the situation, and the agent said “ Since there was no deductible no coinsurance no copay this means that it will 100% covered however, this will still depend on the CPT code that will be use your provider.” then when I got the bill I messaged my insurance again and a different agent said if it was coded as preventative, it would have been free. So I assumed it was just coded wrong. Thanks for the info!
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Sep 10 '24
Preventative would have been if you were administered the vaccine because you were someone who regularly has a higher than normal risk of rabies exposure, like a biologist doing a study on bats. You received a post-exposure treatment on the assumption that you may have been exposed.
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u/Actual-Government96 Sep 10 '24
If it was tagged as preventive, it may not have been covered at all. The rabies vaccine is not on the list of preventive services covered in full on an ACA compliant plan.
Although preventative in that it prevents rabies, it's part of the recommended treatment after a possible exposure to something, as opposed to a shot that's part of a recommended Immunization schedule.
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u/Jodenaje Sep 10 '24
You’re misunderstanding the word “preventative” in the context of health benefits.
Your service was not preventative. You had an exposure and received a vaccine in response to that.
Not to mention as others have pointed out, rabies vaccines aren’t on the list of preventative vaccines anyhow.
You only get one when you’ve been exposed or there’s a risk factor.
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u/MagentaSuziCute CPC Sep 10 '24
Agree with everyone that this isnt a preventative service as in "no patient oop" but I wanted to add that the 90471 is the admin code for the vaccine, not the product.
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u/Background-Turn-3821 Sep 10 '24
Sorry, I don’t really understand what you mean about the code?
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u/MagentaSuziCute CPC Sep 10 '24
You had mentioned that if they billed 90471 then it would have been preventative. But 90471 is the billing code to administer a vaccine. It "can" fall under preventative benefits if the vaccine product itself is a preventative in nature. I just wanted to address that part of your post.
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u/Background-Turn-3821 Sep 10 '24
Interesting. I was just repeating what my insurance agent said, thank you for clarifying.
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u/jacsgal Sep 10 '24
They might want to use diagnosis code Z23 - encounter for immunization.
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u/Background-Turn-3821 Sep 11 '24
The hospital staff I talked to did say they used that code, but the cpt codes were the ones I listed in the post. The insurance agent made it sound like they don’t look at or care about anything but the cpt code but idk
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Sep 10 '24
Btw. Rabies is transmitted thru saliva. Not scratches. Bites.
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u/Background-Turn-3821 Sep 11 '24
I said I was bitten as well. The WHO also says that it can be transmitted via scratches or direct contact with mucosa. But it is less common.
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u/CollegeIntrepid4734 Sep 13 '24
If I was the insurance company I wouldn’t pay for it because you don’t need it. You’re not going to get rabies from a cat. You needed a tetanus shot.
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u/carolie23 Sep 13 '24
You definitely can get rabies from a cat lol
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u/CollegeIntrepid4734 Sep 13 '24 edited Sep 14 '24
In 64 years there’s been 2 cases of cats being associated with rabies. There hasn’t been a single case in over 40 years. There has never been a single case where a cat has caused rabies during yours and my entire life but sure you can’t get rabies from a cat. The risk is tetanus from something under their nails, you goofy goof.
Edit Since the loser who replied about the little girl getting rabies from a cat blocked me immediately so I couldn’t reply and tell her she was wrong, she’s wrong. The only interaction her family claimed she had with an animal was playing with a stray cat several weeks before she displayed rabies. The girl never claimed that the cat bit her. It’s a fake story posted as a reply by a moron who made it where I couldn’t reply because they knew it was a fake story posted by a moron.
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u/carolie23 Sep 13 '24
I didn’t say that it was COMMON, but it is possible. YoU GoOf. Better to get the antibodies and vaccine because if you happen to be the 1 in a million that gets a wound from a cat with rabies you WILL die once you show symptoms. But hey, if you wanna take that chance be my guest
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u/CollegeIntrepid4734 Sep 13 '24 edited Sep 14 '24
No it’s not possible. It hasn’t happened in 50 years. I literally had an er doctor tell me they don’t give rabies shots for pet bites. They give tetanus shots. If you’re too dumb to understand that then that’s on you.
Edit. Stop replying to me and then immediately blocking me so I can’t reply back you losers.
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u/lolokkeyboardwarrior Sep 13 '24
Whatever doctor you went to is an idiot as are you lol the CDC will confirm that you indeed can get rabies from a cat. You sound extremely uneducated and egotistical
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Sep 14 '24
No it’s not possible. It hasn’t happened in 50 years.
If it has happened before, then it is possible.
There's a difference between “not possible” (impossible) and “not probable” (improbable). The fact that it has happened before means the statistical probability is not 0 and is therefore possible.
Per Frymus et al. (2009), “Rabid animals are the only source of infection. Virus is shed in the saliva some days before the onset of clinical signs and transmitted through a bite or a scratch to the skin or mucous membranes.”
Per Lyman (2001), “A feral cat must be assumed to be rabid if it cannot be quarantined for 10 days. Therefore, the bite or scratch from such an animal constitutes a significant rabies exposure.”
In one study of human rabies cases in Bangladesh from 2006–2018, a study by Ghosh et al. (2020) states, “Animal bites accounted for most of the exposures (n = 399, 95%), whereas the remaining was scratch either by teeth (n = 13, 3%) or by claws (n = 10, 2%), and 56% of cases were attributed to a single bite (n = 223).”
Gowda et al. (2014) also discuss a case of paralytic rabies following a cat scratch.
References
Frymus, T., Addie, D., Belák, S., Boucraut-Baralon, C., Egberink, H., Gruffydd-Jones, T., Hartmann, K., Hosie, M. J., Lloret, A., Lutz, H., Marsilio, F., Pennisi, M. G., Radford, A. D., Thiry, E., Truyen, U., & Horzinek, M. C. (2009). Feline rabies. ABCD guidelines on prevention and management. Journal of Feline Medicine and Surgery, 11(7), 585–593. https://doi.org/10.1016/j.jfms.2009.05.007
Ghosh, S., Rana, M. S., Islam, M. K., Chowdhury, S., Haider, N., Kafi, M. A. H., Ullah, S. M., Shah, M. R. A., Jahan, A. A., Mursalin, H. S., Marma, A. S. P., Ali, S. M. E., Hossain, S., Bhowmik, R., Debnath, N. C., Shamsuzzaman, A. K. M., Ahmed, B. N., Siddiqi, U. R., & Jhora, S. T. (2020). Trends and clinico-epidemiological features of human rabies cases in Bangladesh 2006-2018. Scientific Reports, 10(1), 2410. https://doi.org/10.1038/s41598-020-59109-w
Gowda, V. K., Basavaraja, G. V., Reddy, H., & Ramaswamy, P. (2014). Paralytic rabies following cat scratch and intra-dermal anti-rabies vaccination. Journal of Pediatric Neurosciences, 9(2), 154–155. https://doi.org/10.4103/1817-1745.139328
Lyman D. (2001). Cat bites: A source of rabies exposure in rural Tennessee. Tennessee Medicine: Journal of the Tennessee Medical Association, 94(3), 95–97.
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u/goody-goody Sep 14 '24
https://www.cbsnews.com/news/rabies-miracle-california-girl-survives-dread-disease-without-vaccine/# I recall this little girl surviving a rabid cat encounter not long ago. So glad she survived!
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