ED Coding and Reimbursement Alert

Double check your code assignments to make sure you comply with payer instructions.

Flu season can be a busy time in the emergency department, especially if an epidemic hits the area. Although ideally not the place for preventive care, your ED physician may provide flu shots for certain patient populations that seek treatment there. To better recoup deserved reimbursement for these services, take note of the differences between CPT® and Medicare for flu vaccine codes.

CPT® has several codes describing administration of influenza virus vaccine depending on the formula of the vaccine, method of administration, and age of the patient.

For example, the variables of "split virus" and "preservative free" and "pandemic formula H1N1" are used to differentiate codes describing specific vaccinations.

Tip: Watch for intramuscular as opposed to intranasal delivery in the notes to select the code that accurately describes the service provided.

2011 CPT Codes for Influenza Vaccine Administration

• 90656 Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
• 90657 Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use
• 90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use
• 90660 Influenza virus vaccine, live, for intranasal use
• 90661 Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
• 90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
• 90664 Influenza virus vaccine, pandemic formulation, live, for intranasal use
• 90666 Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
• 90667 Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use
• 90668 Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use

Medicare Has its Own Codes

Medicare has its own G code, G0008 (Administration of influenza vaccine), to use in place of the CPT® code alternatives describing administration of the vaccine.

CMS also created a set of Q codes to differentiate the brand of vaccine in use in order to base payment accordingly. Those codes along with the pricing as of Oct. 1, 2011 are as follows:

• Q2035 (Afluria). The national limit is $11.543.
• Q2036 (Flulaval). The national limit is $8.784
• Q2037 (Fluvirin). The national limit is $13.652.
• Q2038 (Fluzone). The national limit is $13.306.
• Q2039 (Not otherwise specified flu vaccine). (Payment limit set by Local carrier/MAC).