Gastroenterology Coding Alert

You Be the Coder:

Hone Your Hepatitis Injection Reporting With This Ready Reckoner

Published on Tue Apr 07, 2015

Question: Our gastro office is getting queries about hepatitis A and hepatitis B vaccination injections. We have the medication in the office. How should I code it?

Colorado Subscriber

Answer:You have not specified whether the patients are Medicare or not.

For Medicare, you are only allowed to bill hepatitis B vaccination. You should bill G0010 (Administration of hepatitis B vaccine) for the administration of the vaccine. For the vaccine itself, you can bill according to the following table:

90740 -- Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use;
90743 -- Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use;
90744 -- Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use;
90746 -- Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use; and
90747 -- Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use.

If the primary purpose for the office visit is to receive a vaccine or if a vaccine is the only service billed on a claim, you should append the following diagnosis code to justify the vaccination.

V05.3 (Need for other prophylactic vaccination and inoculation against viral hepatitis)

For Non-Medicare subjects, you should report 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]) for the administration.

For the vaccine, you can report:

90632 -- Hepatitis A vaccine, adult dosage, for intramuscular use
90633 -- Hepatitis A vaccine, pediatric/adolescent dosage-2dose schedule, for intramuscular use
90634 -- Hepatitis A vaccine, pediatric/adolescent dosage-3dose schedule, for intramuscular use
90636 -- Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use) for A and B.

When you report 90633, the payer knows you’ll be administering two doses of the vaccine within a certain timeframe. Some payers specify a minimum of 181 days between doses; others require a year. Payers may have similar guidelines applicable to code 90634.

Verify guidelines for the payer in question so your physician can provide the service according to those parameters. Then make sure the physician documents when a vaccine is the second or third dosage of the schedule, so the payer will know how to handle the claim appropriately.

Watch out: If your nurse provides the administration (90471), you should be wary of reporting an E/M visit. The National Correct Coding Initiative bundles the codes for immunization administration for vaccines and toxoids with 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician…), and you can’t break the bundles.