Internal Medicine Coding Alert

Question: Should we still be reporting codes 90740-90748 for hepatitis B vaccines? I've heard rumors of new HCPCS Q codes, but I'm not sure whether these are in effect.

Pennsylvania Subscriber

Answer: First things first: You can forget about the HCPCS Q codes. CMS issued program transmittal AB-02-185 in late January, which rejected the 2003 HCPCS Q codes 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).

For hepatitis B vaccines, you need to report two separate codes, one for the immunization administration, 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]), and a code for the vaccine product itself (90740-90747).

Although Medicare started accepting codes 90740-90747 on Jan. 1, 2003, carriers will not accept these codes until April 1. So for claims for non-Medicare carriers containing only hepatitis B vaccine codes with dates of service between Jan. 1 and March 31, you should hold the claims in your system and submit them in April. For claims with additional services furnished on the same date, you may remove the vaccine charge and then submit an adjustment bill in April to receive payment for the vaccine CPT code. This way you can still receive prompt payment for the other services.

Don't expect to get reimbursed for a hepatitis B administration (90471). According to the Medicare Carriers Manual, hepatitis B immunization injections are not paid under the Medicare Physician Fee Schedule. Instead, payment is made under Section 52020 of the Medicare Carriers Manual, which 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.

Answers to You Be the Coder and Reader Questions were provided by Kathy Pride, CPC, CCS-P, HIM applications specialist with QuadraMed, a national healthcare information technology and consulting firm based in San Rafael, Calif.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with physicians on compliance, documentation, coding and quality issues for RCH Healthcare Advisors LLC, a Fort Lauderdale, Fla.-based healthcare consulting company.