Oncology & Hematology Coding Alert

Question: Is H1N1 a pandemic? What are the coding options for reporting H1N1 vaccination? Can we submit codes for both type of vaccine and administration of vaccine?

New Jersey Subscriber

Answer: You will come across changes in behavior and pattern for the influenza H1N1 pandemic. You code H1N1 vaccination like you would do for any other influenza vaccines. According to the Centers of Disease Control and Prevention (CDC), the H1N1 virus that caused that pandemic is now a regular human flu virus and continues to circulate seasonally worldwide. 

As a general rule, you will report most types of flu injections, including a vaccine like the H1N1 shot, using two codes:

• A code for the flu vaccine itself, depending upon the type of vaccine (injectable liquid, intranasal mist, intraoral), whether it’s preservative-free and whether the receiver is a Medicare beneficiary.

            o You will use from within 90654-90688 codes for the particular vaccine you may using. Use from within Q2033-Q2039 for Medicare beneficiaries, when applicable

• A code for the administration of the injection 

            o Submit 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) for single injection
            o Submit 90472 (…each additional vaccine [single or combination vaccine/toxoid] [List separately in addition to code for primary procedure]) for subsequent injections
            o Submit 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]) for single intranasal or intraoral application
            o Submit 90474 (…each additional vaccine [single or combination vaccine/toxoid]…) for additional intranasal or intraoral applications.

You will use administration code G0008 (Administration of influenza virus vaccine) for Medicare-only patients (and those that follow Medicare guidelines).

Tip: Make sure you report V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; other viral diseases; influenza) as your diagnosis. Medicare has fixed the payment at the same rates as the administration of the seasonal influenza vaccine (G0008).