Ob-Gyn Coding Alert

Question: I'd like to know how to bill for H1N1 flu shots. Specifically, what E/M code should I use? Also, can we bill private payers for the shot?

Washington subscriber

Answer: First of all, billing an E/M code when the purpose of the visit is the flu shot itself is a mistake. Remember that the E/M must be separate and significant from the shot. Billing 99211 (Office or outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician...) and modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) does not suffice.

Try this: You would report the H1N1 flu product with the general pandemic vaccine code 90663 (Influenza virus vaccine, pandemic formulation), according to an AMA Fact Sheet On Reporting For H1N1. Use the new administration code 90470 (H1N1 immunization administration (intramuscular, intranasal), including counseling when performed) along with it. Note that the new code includes any counseling related to giving the vaccine that is required.

On Oct. 20, the Centers for Disease Control (CDC) announced the federal government purchased the 2009 H1N1 influenza vaccine and ancillary supplies (syringes, needles, sharps containers, and alcohol swabs). The federal government will provide these items free of charge to all providers participating in this voluntary vaccination effort. Therefore, you won't charge the patient for the 2009 H1N1 vaccine itself. In other words, those receiving federal funding will get the vaccine for free, but you can bill private insurers as long as your practice is not getting it for free.