Gastroenterology Coding Alert

Question: How should I bill for hepatitis A or hepatitis B vaccinations? I have been using the code for the hepatitis vaccine with the injection code 90471. While I report the hepatitis diagnosis code, Medicare has paid for the injection but denied the administration. What could be the problem?

Montana Subscriber

Answer: For hepatitis vaccinations, you need to report two separate codes one from the Immunization Administration section (90471-90474) of the CPT manual and the other from the Vaccine, Toxoids section (90476-90749). Codes from the latter section identify the vaccine product only. These codes are reported in addition to the administration codes.

CPT says that you need to be sure to report the exact vaccine product administered. If you administer a hepatitis A vaccine, then report one of the vaccine codes 90632-90634, along with 90471 for the administration. For a hepatitis B vaccine, report one of the vaccine codes 90740-90747, along with 90471.

The problem you are probably facing with Medicare is that it does not accept the administration codes 90471-90472. The Medicare Carriers Manual states that injection services that are hepatitis B immunizations are not paid under the Physician Fee Schedule. Instead, payment is made under section 5202 of the Carriers Manual. This section states that when a separate charge for an injection is reported, the maximum allowable charge may not exceed the ingredient and supply cost plus an additional $2 allowance for the injection service. Code G0010 (Administration of hepatitis B vaccine when no physician fee schedule service on the same day) is listed in the Physician Fee Schedule, but it has an "X" status code. This means that this item is not in the statutory definition of "physician services" under the fee schedule, and no payment amounts or RVUs are available.

Therefore, the problem is not the diagnosis code that you are reporting, such as V02.61 (Hepatitis B carrier). More than likely, you are having problems with Medicare's refusal to reimburse the injection service for hepatitis B patients.