Pediatric Coding Alert

Hint: Watch updated status for several flu vaccines.

If July came and went without you reading through the American Medical Association's new and revised vaccine and Category III codes, slow down and take a closer look. Check the updated status classifications for several vaccine codes and prepare to use them, now that the FDA has given its green light.

Code 90650 Gains FDA Clearance

The AMA published a new code for Human Pailloma virus (HPV) vaccine on its website in October 2009. CPT 2010 does not include 90650 (Human Papilloma virus [HPV] vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use), but you've been able to report it following payer guidelines.

"The CPT coding process allows for development of new codes and numbers, but they don't become active until FDA approved," explains Richard L. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville. New codes might be included in CPT, but have a "lightning bolt" symbol designating pending FDA approval.

Status change: The latest coding information from AMA removes the lightning bolt symbol from 90650, effective back to the FDA approval date of Oct. 16, 2009. Watch for 90650 in CPT 2011 as a fully approved code.

"Most payers won't pay for vaccines until they're FDA approved," says Tuck. "Even after approval, there can be a lag time from three to six months until payers pick up on the fully approved code."

Donelle Holle, RN, pediatric coding consultant with Pedscoding, Inc., agrees -- and adds a caution of her own. "If the code isn't indicated in the CPT book yet, many carriers will not recognize the code," she says. "They'll give you an 'invalid code' denial, even though you can officially use the code."

Good news: Once news of code 90650's FDA approval spreads, you should be able to file claims unhindered.

Flu Vaccines Move to 'Pending' Status

The AMA implemented four influenza vaccine codes July 1, 2010, each with a "pending FDA approval" notation:

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.

The codes' six-month implementation period began Jan. 1, 2010. You can include any of the codes on your claims although, as stated above, some payers might not reimburse yet. Expect to see 90664-90668 published in CPT 2011.

Prepare for Intradermal Flu Vaccine

The AMA added to the flu vaccine family by releasing an additional code on July 1. Make a note to include 90654 (Influenza virus vaccine, split virus, preservative free, for intradermal use) as an option beginning Jan. 1, 2011 and watch for its inclusion in CPT 2012.

Heads up: Experts say to watch for new vaccine administration codes in 2011 based on the number of components in the vaccine. The changes could make a big difference in your coding and your practice's bottom line, so Pediatric Coding Alert will keep you up-to-date as the changes come.