Ob-Gyn Coding Alert

Test yourself: Do you know what the CPT manual 'lightning symbol' means?

If July came and went without you reading through the American Medical Association's new and revised vaccine codes, slow down and take a closer look. Check the updated status classifications for several vaccine codes and prepare to use them, now that the FDA has given its green light.

Code 90650 Gains FDA Clearance

You may already be aware that the AMA published a code for Human Pailloma virus (HPV) vaccine on its Website back in October 2009. Also, you may have spotted this 90650 (Human Papilloma virus [HPV] vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use) in your CPT 2010 book -- with the lightning bolt symbol. That symbol indicates this vaccine was pending FDA approval at the time of publication.

Status change: The latest coding information from AMA removes the lightning bolt symbol from 90650. In other words, your CPT 2011 book will list 90650 as a fully approved code. This change is effective back to the FDA approval date of Oct. 16, 2009.

What this means to you: If you have gotten a denial on this code from Oct. 16, 2009 through the present day, you can make a case for payment. Note: "Most payers won't pay for vaccines until they're FDA approved," explains Richard L. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville. "Even after approval, there can be a lag time from three to six months until payers pick up on the fully approved code."

To learn more about early release codes, go to URL: http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about-cpt/category-i-vaccine-codes.shtml.

Don't Forget 90649, 90650 Distinction

Remember, you still have the Gardasil code (90649, Human Papillomavirus [HPV] vaccine, types 6, 11, 16, 18 [quadrivalent], 3 dose schedule, for intramuscular use), which ob-gyns use for types 6 and 11 (which cause genital warts) and types 16 and 18 (which cause cervical cancer).This code is in addition to the new Cervarix code (90650), which ob-gyns use for types 16 and 18 (which cause cervical cancer). The difference between the two may depend on physician preference and/or cost of the vaccine. Studies show the new bivalent vaccine is 90 percent effective in preventing types 16 and 18 HPV.