Gastroenterology Coding Alert

Question: We have had problems reporting and receiving reimbursement for hepatitis B vaccines lately. I heard that there is a new change in Medicare's policy concerning these vaccines. Is this true, and are there any new codes I should be aware of? New Jersey Subscriber Answer: There has been a lot of confusion recently regarding Medicare's policy on certain vaccines. On Nov. 1, 2002, Medicare issued Transmittal 1778 that was to be implemented on Jan. 1, 2003. The transmittal stated that certain hepatitis B vaccine codes 90740, 90743, 90744, 90746 and 90747 were no longer valid for Medicare. These codes were to be replaced by Q3021 (Injection, hepatitis B vaccine, pediatric or adolescent, per dose), Q3022 (Injection, hepatitis B vaccine, adult, per dose) and Q3023 (Injection, hepatitis B vaccine, immunosuppressed patients [including renal dialysis patients], per dose). Vaccine codes 90723 and 90748 were determined to be inappropriate for preventive benefit and removed. G0010 (Administration of hepatitis B vaccine ...) was to be reported for the administration of the vaccine and reimbursed at the same rate as 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular). The transmittal listed V05.3 (Need for other prophylactic vaccination; viral hepatitis) as the appropriate diagnosis code to use with the new Q codes.

However, on Dec. 31, 2003, CMS issued Program Memorandum AB-02-185 to change Transmittal 1778. It states that the decision to make these changes was reconsidered. The new Q codes will not be established at this time, and 90740-90747 are reactivated beginning Jan. 1, 2003. The policy regarding 90723 and 90748 is still correct. This change will be implemented starting April 1, 2003. In the meantime, reimbursement for these services will be slightly complicated: Beginning Jan. 13, 2003, if you send in a claim with a date of service Jan. 1, 2003, through March 31, 2003, that contains the 90740-90747 codes, the claim will be returned to you. Claims for hepatitis B vaccines containing CPT codes listed above with dates from Jan. 1, 2003, to March 31, 2003, should be held in your system and submitted for payment starting April 1, 2003. If you provide additional services that would be reported on the same claim as the vaccine code, remove the charge for the vaccine in order to receive payment for the other services and submit an adjustment bill in April to receive payment for the vaccine. Any claims containing HCPCS Q codes will be returned to you. Clinical and coding expertise for You Be the Coder and Reader Questions provided by Linda Parks, MA, CPC, CCP, lead coder at Atlanta Gastroenterology Association; and Michael Weinstein, MD, a gastroenterologist in Washington, D.C., and former member of the CPT advisory panel.