Oncology & Hematology Coding Alert

Check for 90673 in the possible flu vaccine options.

Each year, you face a challenge in flu coding as the virus strains change and new products are added to the market -- and 2014 brings adjustments you’ll need to know about. Equip yourself with the following influenza vaccine coding advice for accurate reporting.

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In your CPT® 2014 manual, you’ll see new flu vaccine code 90673 (Influenza virus vaccine, trivalent, derived from recombinant DNA [RIV3], hemagglutinin [HA] protein only, preservative and antibiotic free, for intramuscular use).

“This code, which was FDA approved in January 2013, was released on July 1, 2013, for implementation on January 1, 2014,” says Kent Moore, senior manager for physician payment at the American Academy of Family Physicians. The AMA provides flu code history and updates at www.ama-assn.org/resources/doc/cpt/vaccine-codes.pdf.

Watch for codes 90685-90688 in the 2014 Manual

Last year, the CPT® Editorial panel announced four influenza vaccine codes that went into effect in January 2013, but they weren’t printed in the 2013 CPT® book. Consequently, your 2014 manual will mark these codes as new:

• 90685, Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use (Fluzone Quadrivalent)
• 90686, Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use (Fluarix Quadrivalent)
• 90687, Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
• 90688, Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use.

These codes are essentially the quadrivalent version of trivalent codes 90655-90658. As CPT® Assistant (August 2013) explains, a quadrivalent flu vaccine protects against four (quad-) flu strains, two each of types A and B. Trivalent vaccines protect against two type A strains and one type B strain for a total of three (tri-).

Caution: Both 90687 and 90688 carry the lightning bolt symbol in AMA materials, indicating that FDA approval is pending. So check for FDA approval of each vaccine represented by the code before using the associated code.

Remember: These codes describe only the vaccine product. Once FDA approval is granted and the vaccine is available in the US, the administration would be separately reportable using 90460-90466 or 90471-90472 or even perhaps G0008.