Gastroenterology Coding Alert

Question: Our practice treats many patients with hepatitis B and C. One of our doctors recently read that administering a dose of hepatitis A vaccine could enhance the treatment of these patients. Can we be reimbursed for giving these immunizations? What CPT codes would we use to report them?

Tennessee Subscriber

Answer: You should be prepared for denials because this is not a standard use of the hepatitis A vaccine, according to Arthur Lamon Willis, CPC, an independent coding consultant in Lawtey, Fla. You may want to contact your commercial payers before you begin this treatment to find out what their policies are regarding the use of the vaccine.

For a commercial insurance company that will cover such a claim, the appropriate CPT codes to use would be 90471 (immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections and/or intranasal or oral administration]; one vaccine [single or combination vaccine/toxoid]) to report the administration of the vaccine and 90632 (hepatitis A vaccine, adult dosage, for intramuscular use) for the vaccine itself. No modifiers are needed.

Although there are some exceptions to this rule, Medicare generally does not cover vaccinations. There is no HCPCS code for the hepatitis A vaccination as there is for the influenza, hepatitis B and pheunococcal vaccinations that the agency does cover.

Additional information for this months Reader Questions was provided by Pat Stout, CMT, CPC, an independent gastroenterology coding consultant in Knoxville, Tenn.