Cardiology Coding Alert

The AMA fast-tracked a CPT code for H1N1 vaccine administration, so to avoid denials, you're now going to have to check which of three administration code options your major payers want.

There's no need to wait for Jan. 1 to use a brand-new CPT code for H1N1 vaccine administration -- 90470 (H1N1 immunization administration [intramuscular] [intranasal] including counseling when performed]) is effective immediately, announced the AMA in "CPT Codes for 2009 H1N1 Influenza Immunizations"(www.ama-assn.org/ama/pub/h1n1/resources/cpt-codes.shtml).

In addition, CPT revised the existing flu vaccine code from a generic pandemic code to specify H1N1. Revised code 90663 will now read "Influenza virus vaccine, pandemic formulation, H1N1." The revision adds "H1N1" to the descriptor shown in your CPT 2009 manual.

Remember: You should not charge for the vaccine.According the CDC Web site, the "2009 H1N1 influenza vaccine and ancillary supplies (syringes, needles, sharps containers, and alcohol swabs) have been purchased by the federal government and provided free of charge to all providers participating in this voluntary vaccination effort. Therefore, it will not be permissible to charge for the 2009 H1N1 vaccine itself" (www.cdc.gov/H1N1flu/vaccination/statelocal/vaccine_financing.htm). If you choose to report the codes for the vaccine for tracking purposes, you should not associate a fee with the vaccine (or if you must include an amount, limit it to $0.01). Only the vaccine administration is eligible for reimbursement.

"Medicare had established the precedent for a specific code for H1N1 administration with its own G code," notes Richard Tuck, MD, FAAP, a physician at PrimeCare of Southeastern Ohio in Zanesville.

CMS added H1N1 vaccine admin code G9141 (Influenza A [H1N1] immunization administration [includes the physician counseling the patient/family]), effective Sept. 1 (Transmittal 1810, CR 6617), as described in Cardiology Coding Alert, Vol. 12, No. 12,  "Prepare for Swine Flu Season With G9141, G9142 Know-How."

"It's very important that when you bill Medicare Fee-for-Service, that you use the G code," noted CMS's Stewart Streimer during an Oct. 6 Physicians Open Door Forum (ODF). "Do not use the newly-developed CPT code that's just been announced by the AMA," he said.

And note that some non-Medicare payers want you to use G9141 (based on the information available at the time of publishing).

Tip: For CMS, the correct code for the H1N1 vaccine is G9142 (Influenza A [H1N1] vaccine, any route of administration), but as explained above, you should not charge for the vaccine.

Some other payers want you to continue using the general vaccine administration codes 90465-90474 (Immunization Administration for Vaccines/Toxoids).

Best bet: Create an Excel spreadsheet that lists which H1N1 vaccine administration code each of your payers requires.

Bonus dx tip: Code V04.81 (Need for prophylactic vaccination and inoculation against certain diseases; influenza) is the diagnosis code for H1N1 vaccinations.