Oncology & Hematology Coding Alert

If you're planning to administer the vaccination for H1N1- also known as the "swine flu" -- the odds of collecting for the vaccine administration recently improved.

CMS released Transmittal 1810, CR 6617 (www.cms.hhs.gov/transmittals/downloads/R1801CP.pdf), adding two new H1N1 vaccine codes to the fee schedule, effective Sept. 1:

• G9141 (Influenza A [H1N1] immunization administration [includes the physician counseling the patient/family]) refers to the vaccine administration

• G9142 (Influenza A [H1N1] vaccine, any route of administration) is the code for the vaccine.

Important: Because the H1N1 vaccine is available to providers free of charge, you should not bill Medicare for the vaccine -- only for the administration, said CMS's Stewart Streimer during an Aug. 25 CMS Open Door Forum.

So you should report one unit of G9141 for each H1N1 vaccine administration. If you do report G9142 (the vaccine), CMS will deny only that line item, according to MLN Matters article SE0920 (www.cms.hhs.gov/MLNMattersArticles/downloads/SE0920.pdf).

CMS intends to pay you the same amount for G9141 as it reimburses for G0008 (Administration of influenza virus vaccine) and G0009 (Administration of pneumococcal vaccine). "The reimbursement varies by state, but ranges from about $18 to $25," says Jay Neal, a coding consultant in Atlanta. You can find your state's rate at www.cms.hhs.gov/AdultImmunizations/Downloads/AdminRates09.pdf.

Tip: Although Medicare normally pays for just one vaccination per year, it will pay for both a seasonal flu vaccine and an H1N1 vaccine if both are medically necessary, according to the MLN Matters article. The H1N1 vaccine will not be available as early as the seasonal vaccine, and the Centers for Disease Control (CDC) announced the H1N1 vaccine initially may be available in limited quantities. The CDC advises that the following groups should receive the vaccine before the general public:

• Pregnant women

• Caregivers of children younger than 6 months of age

• Healthcare and emergency medical services personnel with direct patient contact

• Children 6 months through 4 years of age

• Children 5 through 18 years of age who have chronic medical conditions.

The fee schedule also adds an additional HCPCS code for bevacizumab (Q2024, Injection, bevacizumab, 0.25 mg). But just because you have this new code doesn't mean you should use it.

Experts speculate that Q2024, effective Oct. 1, will be appropriate for ophthalmic use of the drug because of the low quantity in the descriptor -- one unit per 0.25 mg -- and that oncology coders should continue to use J9035 (Injection, bevacizumab, 10 mg) for the larger doses cancer patients typically require. The Oncology and Hematology Coding Alert will keep you posted on any news from CMS on the code's proper use.

Tip: CMS has assigned Q2024 procedure status "E," which means it excludes the code from the Medicare Physician Fee Schedule by regulation. However, Medicare Administrative Contractors (MACs) may pay it under "reasonable charge procedures."