Medicare Compliance & Reimbursement

Inoculate yourself against ignorance of new vaccination codes

You'll have six new vaccination codes starting in January--but only three of them will be in your CPT book.

The American Medical Association (AMA) released three new influenza vaccination codes (90661-90663) on July 1, even though they're not effective until Jan. 1. These codes cover flu vaccines which are derived from cell cultures (90661), split virus (90662) and pandemic formulation (90663).

But the AMA's CPT Editorial Panel approved three other vaccination codes in June--too late to go into the 2008 CPT book. The codes will still take effect in January, but they won't appear in print until the 2009 CPT book. You can see a list online at www.ama-assn.org/ama1/pub/upload/mm/362/vaccinecodes.pdf.

One new code, 90650, covers vaccination for human papilloma virus types 16 and 18. Another new code, 90681, covers immunization for attenuated human rotavirus. The third new code, 90696, is for diphtheria and tetanus toxoids, vaccines administered to children aged four through six.

Prepare To Use New Category III Codes

You'll also have some new Category III codes to bill starting in January. These are temporary codes for new technologies, and convincing your carrier to pay for them can be a hassle. But you should still report these codes, because it makes them more likely to become regular Category I codes in the future, say experts.

The new Category III codes for 2008 include:

• Electrocardiogram, 64 leads or greater (0178T-0180T). You'll still use 93000-93010 for a routine electrocardiogram (EKG) with at least 12 leads. But for an EKG with 64 or more leads, you should use 0178T-0180T, which took effect in July 2007 and will appear in the 2008 CPT book.

New code 0178T covers an EKG with graphics and analysis and interpretation and report. You'll use 0179T for tracing and graphics only, and 0180T for interpretation and report only.

• New code 0181T covers bilateral air impulse stimulation to determine a corneal hysteriesis. It includes interpretation and report.

• High-dose electronic brachytherapy, per fraction (0182T). You can't report this code with a whole host of radiology codes: 77761-77763, 77776-77778, 77781-77784 and 77789.

• Non-contact, low-frequency, non-thermal ultrasound (0183T). This includes topical applications, if any, plus wound assessment and instructions for ongoing care.

• Excision of a rectal tumor via Transanal Endoscopic Microsurgical (TEMS) approach (0184T). You'll still use 45160 or 45170 for a non-endoscopic excision of a rectal tumor. You should not use 0183T with 45300-45327 or 69990, the descriptor notes.

• You'll also have a new code (0185T) for multivariate analysis of patient findings with a quantifiable computer probability assessment, including report. You shouldn't report this code with CPT code 99090.

• New code 0186T covers suprachoroidal delivery of a pharmacologic agent, and doesn't include the supply of medication.

• Finally, you'll be able to use new code [...]