Diagnosis code for justification of antiviral

Discussion in 'Your Living Room' started by hopefulstill, Jan 27, 2016.

  1. hopefulstill

    hopefulstill Member

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    Jul 27, 2015
    I am seeing a new ENT this afternoon. If I can convince him of the efficacy of antivirals, what diagnosis code would he use. Wouldn't the insurance company kick it back if he is treating Meniere's??
     
  2. scott tom

    scott tom Active Member

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    May 14, 2015
    Depends on the insurance. Mine doesn't question it. I have BCBS.
     
  3. Vicki

    Vicki Guest

    What my primary did because she was hesitant to write a script for an AV for Meniere's she tested me for HSV and since it came back positive she felt okay to write me scripts for acyclovir and she said if anyone questions it she has the positive HSV bloodwork.
     
  4. nicmger

    nicmger Member

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    I don't think that the prescription insurance looks at/cross matches to doctor visit codes. Prescription, in my opinion, would be kicked back only because your plan does not cover it or the doctor didn't write the dosage or instructions clear enough.

    Don't believe that prescription coverage will be your roadblock - if you can get the dr to write the script congrats!
     
  5. nicmger

    nicmger Member

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    May 12, 2014
    Should add...if your prescription company for whatever reason didn't want to cover it, you can also call around for a cash price. I did that for a while because the mail-order required by my insurance for ongoing prescriptions would not work with me to fill with a certain manufacturer. So I called around. Actually by me was able to get a month supply cash for about $50.
     

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