Oncology & Hematology Coding Alert
Use Specific Codes for Prophylactic Vaccinations
Question: We billed 90732 and 90471 with a diagnosis of V06.6. We have received a denial. What are the correct CPT® codes used to bill for a pneumovax in Medicare?
Colorado Subscriber
Answer: From your diagnosis, it seems evident that you are coding for both influenza virus and PPV vaccines together. You are reporting V06.6 (Need for prophylactic vaccination and inoculation against streptococcus pneumoniae and influenza) for the two together. In the past, you’ve linked these vaccinations to V03.82 (Need for prophylactic vaccination and inoculation against streptococcus pneumoniae [pneumococcus]) and V04.81 (Need for prophylactic vaccination and inoculation against influenza).
When reporting vaccination codes, you have to report both the actual vaccine codes and the administration codes. In Medicare, you have to separately report the administration codes for the seasonal influenza virus (G0008, Administration of influenza virus vaccine) and pneumococcal (G0009, Administration of pneumococcal vaccine) vaccines. Medicare will pay both administration fees if a beneficiary receives both the seasonal influenza virus and the pneumococcal vaccines on the same day.
Medicare does not reimburse administration code 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) for this scenario.
Along with G0009 for the administration, also report the 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use) for the vaccine will be sufficient. To instead report the 13-valent pneumococcal vaccine, you would instead assign 90670 (Pneumococcal conjugate vaccine, 13-valent [PCV13], for intramuscular use).
If you are also billing for the flu vaccine, you should report the vaccine based on the specific type of flu vaccine the patient received. Use the HCPCS codes that CMS has created (when applicable), such as the following:
For additional information regarding administration of these vaccines and other preventive services, see refer to the following link for a handy chart developed by CMS: http://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/Downloads/MPS_QuickReferenceChart_1.pdf
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