Medicare Compliance & Reimbursement

CPT® Announces New Vaccine Codes for CPT® 2014

You probably haven’t even ordered your CPT® 2014 book yet, but it’s important to know that codes are already being approved that will make their way into the volume. On July 1, the American Medical Association announced the approval of several new vaccine codes that will be published in CPT® 2014.

The main code that is new to most readers is 90673 (Influenza virus vaccine, trivalent, derived from recombinant DNA [RIV3], hemagglutnin [HA] protein only, preservative and antibiotic free, for intramuscular use), which was just released on July 1.

The other codes that CPT® announced will make their way into CPT® 2014 may not be in the code book yet, but have already been valid to report since Jan. 1, and include the following:

90685 — Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use;

90686 — ...when administered to individuals 3 years of age and older, for intramuscular use;

90687 — Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use; and

90688 — ...when administered to individuals 3 years of age and older, for intramuscular use.

To read about the new vaccine codes, visit www.ama-assn.org/resources/doc/cpt/vaccine-codes.pdf.

The OIG Is Watching How Many Vaccinations You Provide

A Maryland home health provider is in the hot seat for providing — and billing Medicare for — repeat pneumococcal vaccinations. And if you’re not careful, you could be next.

Background: "Current vaccination recommendations state that individuals without immune-compromising medical conditions should receive a single pneumococcal vaccination at the age of 65 years or older and that individuals with immune-compromising conditions should receive a second vaccination 5 years after their first," the HHS Office of Inspector General says in a new report, "Potentially Improper Frequency of Pneumococcal Vaccinations for Medicare Beneficiaries" (OEI-07-13-00310). "Medicare instructs providers to administer a pneumococcal vaccination if a beneficiary is uncertain of his or her vaccination history in the past 5 years."

In a study of beneficiaries served from 2007 to 2011, an unnamed Columbia, Md., provider ranked number one on the list of providers furnishing repeat vaccinations under HCPCS code 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immune-suppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use), the OIG says. The HHA administered repeat vaccinations to 754 beneficiaries via locations with multiple NPIs.

Overall, 43 percent of providers gave patients the repeat vaccinations. The remaining patients received vaccinations from different providers. Medicare spent nearly $7 million on the repeat shots, the OIG says. Many of the unnecessary vaccinations "could be reduced through providers’ reviewing the medical history of established patients," the OIG urges. "Tools, such as electronic medical records, may assist in this effort," the agency says in the report at go.usa.gov/bssj.

Home Care Providers Hit By ADRs From All Sides

If the blizzard of ADRs hitting the home care industry is confusing you, you aren’t alone. Some Additional Development Requests include requests for the Home Health & Hospice Medicare Administrative Contractor "mixed in with ADRs for the Recovery Audit Contractor (RAC), the Zone Program Integrity Contractor (ZPIC), and/or the Comprehensive Error Rate Testing (CERT) contractor," points out MAC Palmetto GBA on its website. "Please review your … ADRs very closely. They can be confusing!"

Don’t face additional payment delays or denials because of paperwork mix-ups. "Please make sure you esMD, fax or mail your records to the correct contractor," Palmetto urges.

Reminder: "You cannot send ADR responses to the RAC, ZPIC or CERT via the electronic submission of Medical Documentation (esMD) process," the MAC adds. "esMD only applies to requests that are solely responding to Palmetto GBA requests."

Home Health Agency Faces Survey Complaint Over End Of Life Care

Be sure your communication with both referring physicians and patients is strong, or you may find yourself facing public embarrassment — and worse.

Gentiva Health Services Inc. in Little Rock, Ark., is learning that lesson the hard way. In a story titled "Woman Blames Home Health Care Company for Mother’s Painful Death," Lisa Dietz says her mother screamed in pain at home while dying of lung cancer while Gentiva shuffled her between hospice and home health care so the doctor could run tests, reports KARK 4 News.

Dietz told the news station she called the company over and over again to find out what was going on but kept getting the run-around. Meanwhile, her mother had to go eight days with no pain medication except pills — which she couldn’t swallow — until she died.

Dietz has filed a complaint with the state survey agency, she said.

Gentiva Health Services responded, "Respect for patient privacy and health care privacy laws limit what we can say with regard to individual cases," according to KARK 4 News. "But, it would be important to let KARK-TV viewers know that we were actively working to secure the necessary medical orders in the case you inquired about. Our sympathies and prayers go out to the patient’s family."