Internal Medicine Coding Alert

Question: A new co-worker said that our practice is leaving money on the table by reporting only 90658 when a nurse gives a patient a flu shot. Should we also charge an administration fee?


Illinois Subscriber

Answer: Absolutely. Code 90658 (Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use) represents the vaccine product only, states CPT's "Vaccines/Toxoids" introductory notes. The code's relative value units do not include the cost of the injection supplies and staff services. You should capture these costs with the appropriate administration code.

Depending on the insurer, assign 90471 or G0008. When you submit an influenza vaccination claim to a Medicare carrier, report G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day). For patients on private insurance, use 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]).

Link both the administration code (90471 or G0008) and the vaccine product code (90658) to V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; influenza).

Tip: If the patient receives additional vaccinations, such as a pneumonia shot, report a separate administration service. For Medicare, use G0009 (Administration of pneumococcal vaccine when no physician free schedule service on the same day). For private payers, submit +90472 (... each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]).

Final steps:

1. Report the pneumonia vaccine product with 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use).
 
2. Link G0009/90472 and 90732 to V03.82 (Other specified vaccinations against single bacterial diseases; streptococcus pneumoniae [pneumococcus]).