Oncology & Hematology Coding Alert

Keep these rules in mind for H1N1 coding.

Several codes for pandemic formulation flu vaccines became effective in July and will appear in your 2011 CPT manual, but CMS is sticking to its G-code for H1N1 vaccine supply.

Take a Peek at Pandemic Codes

The following "pandemic" formulation codes were available for use as of July 1, 2010, but their late release meant their first CPT manual appearance is in the 2011 manual. CPT lists these codes as "FDA approval pending":

• 90664 -- Influenza virus vaccine, pandemic formulation, live, for intranasal use
• 90666 -- Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
• 90667 -- Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use
• 90668 -- Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use.

When you do use these codes, use them not for the regular flu, but for widespread illness, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania, Department of Medicine, in Philadelphia. The new codes were created to reflect vaccines that "differ in both formulation and cost, which requires differentiation of products," Pohlig says.

Medicare rule: For Medicare patients, you should continue to report G9142 (Influenza A [H1N1] vaccine, any route of administration) for the vaccine supply (although if you receive the supply free of charge, you should not charge for it).

MLN Matters article MM7120 specifically says Medicare won't recognize 90664, 90666, 90667, or 90668 for H1N1 vaccine (www.cms.gov/MLNMattersArticles/downloads/MM7120.pdf). The article, which has a Nov. 24, 2010, implementation date, also notes that Medicare will not cover 90663 (Influenza virus vaccine, pandemic formulation).

Don't miss: CPT will revise 90663 in 2011 to specify "H1N1": Influenza virus vaccine, pandemic formulation, H1N1.