ED Coding and Reimbursement Alert
When You Check The Status of Your Vaccinations, Don't Forget to Verify Your Vaccine Codes Are Also Up to Date
Subtle changes in 2015 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 or those patients that actually present with other problems that make them vulnerable to poor outcomes from a severe case of the flu. Read on to know about new codes and revisions for 2015.
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: Age, Active/Inactivated, Recombinant or Live Attenuated; preservative (thimerosol, Hg) free, high-dose, administration route, and tri- or quadrivalent. There are new 2015 CPT® codes, including 90630 for quadrivalent, split virus, preservative free, intradermal injection. Don’t forget to capture vaccine administration CPT® codes 90471-90474, in addition to the vaccine codes listed in the table below, says Betty Anne Price, BSN, RN, President and CEO of PRCS, Inc. in Palmetto, FL.
Good news: Medicare continues to cover many seasonal influenza vaccines without coinsurance or co-payment deductions. CMS rescinded Transmittal 3029, replacing it with Transmittal 3033 on Sept. 3, 2014. Medicare payment rates for seasonal vaccines are effective Aug. 1, 2014 through July 31, 2015.
Heads up: Stay alert when using CPT® codes 90654, 90662, 90672, and 90673. Medicare local claims contractors will determine whether the charges are reasonable and necessary for payment. Similarly, payment for HCPCS Q2039 (Flu Vaccine Adult – Not Otherwise Classified) is a local contractor discretion, Price warns.
ED Coding and Reimbursement Alert
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