ED Coding and Reimbursement Alert

Subtle changes in 2017 CPT^® language can cause you to miscode if you don't have the latest versions.

Flu season is ramping up, and it is not unusual to provide flu shots in the ED for patients without access to primary care. Still other patients may present with other problems that make them vulnerable to poor outcomes from a severe case of the flu. Make sure you're up to date with new codes and revisions for 2017.

Chart Documentation Will Drive Vaccine Coder Choice

You'll need to look for these key terms in the chart documentation when coding for influenza vaccines: Active/Inactivated, Recombinant or Live Attenuated; preservative free, high-dose, administration route, and tri- or quadrivalent, but age is no longer a factor is selecting your influenza vaccine code, says Betty Ann Price, BSN, RN, President and CEO of PRCS, Inc. in Palmetto, FL.

The age indications such as children aged six to 35 months have been removed from the revised descriptors of trivalent influenza virus codes (90655-90658) and quadrivalent influenza virus codes (90685-90688) in CPT^® 2017. The revised codes replaced those age distinctions with dosage amounts of either 0.25 or 0.5 ml. The rationale for the change is to better define the vaccinations provided and further encourage reference to the product's prescribing information.

Vaccine codes at a minimum should describe the type of vaccine and route of administration. However, these influenza vaccines also include more detailed information about the vaccine formulation. For example:

90655 (Influenza virus vaccine, trivalent [IIV3], split virus, preservative free, 0.25 mL dosage, for intramuscular use)

There is one new flu vaccine code in 2017, 90674 (Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use). It was added to differentiate that it is a quadrivalent vaccine. The prior code 90661 (Influenza virus vaccine, trivalent [ccIIV3], derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use) has been revised to show that it is trivalent, Price explains.

Be Mindful of Physician Counseling with Flu Vaccine Administration

CPT^® contains two codes that describe face-to-face physician counseling to the patients age 18 or younger, or their family members:

90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered)

+90461 (...each additional vaccine or toxoid component administered [List separately in addition to code for primary procedure])

The word "component" in these code descriptors refers to all antigens in a vaccine that prevent disease caused by one organism and multi-valent antigens or multiple serotypes of antigens against a single organism are considered to be a single component of vaccine. Combination vaccines are those that contain multiple vaccine components. Take note that these codes should not be routinely reported, but coded only when the provider does face to face counseling during the administration of the vaccine, Price adds.