Pediatric Coding Alert

If your payer is denying 90718, you should appeal through the end of the year.

Your CPT® book will be missing a few of your go-to vaccine codes next year, but that doesn't mean you should stop billing them now. Consider the following tips when coding your pediatric immunization services through the end of 2012.

Real-life scenario: A reader contacted Pediatric Coding Alert recently, noting that her payer had suddenly started denying claims for 90718 (Tetanus and diphtheria toxoids adsorbed when administered to individuals 7 years or older, for intramuscular use). Other Codify members had complained about similar denials for 90665 (Lyme disease vaccine, adult dosage, for intramuscular use) and 90701 (Diphtheria, tetanus toxoids, and whole cell pertussis vaccine [DTP], for intramuscular use), with the denial reason being that the codes had been deleted from CPT®.

Reality: The AMA will be deleting these codes consistent with changing clinical immunization indications, but not until 2013. Therefore, a recent alert on the AMA's website states, "It is important to note that these codes remain effective for reporting through December 31, 2012."

If your payer continues to deny claims for these services, send a copy of the AMA's clarification (available at www.ama-assn.org/resources/doc/cpt/vaccine-codes.pdf) with your appeal to ensure payment for your vaccine services.

Look Ahead to Updated Vaccine Codes

In the same memorandum, the AMA also announced several vaccine code changes that will impact your coding for this year and beyond.

For instance: Meningococcal conjugate vaccine code 90644 was FDA-approved on June 14, so you can remove the "lightning bolt" indicator from your CPT® book.

Look to 2013: In addition, CPT® 2013, anticipating changes in influenza immunization products, will include new codes 90653 (Influenza virus vaccine, inactivated, subunit, adjuvanated, for intramuscular use) and 90672 (Influenza virus vaccine, quadrivalent, live, for intranasal use). The codes were released on July 1, but won't be implemented until January 1.

You'll also see CPT® revisions in 2013, when influenza vaccine codes 90655-90660 will include the term "trivalent" in their descriptors. This term simply means that the vaccine includes three influenza viruses, with all three components built into one vaccination.

New Hepatitis Vaccine Will Come Your Way

In February, the CPT® Editorial Panel accepted a new hepatitis B vaccination code for inclusion in CPT® 2013. Code 90739 (Hepatitis B vaccine, adult dosage [2 dose schedule], for intramuscular use) will go into effect on January 1.

Revision: With the introduction of 90739, CPT® will revise hepatitis B vaccine code 90746 to reflect the fact that it describes a three-dose schedule.

Jump Way Ahead to 2014

The CPT® Editorial panel made several more changes. Four additional codes were also announced for inclusion in CPT® 2014. However, these codes will go into effect in 2013. The new codes are listed as follows:

• 90685 -- Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
• 90686 -- ...when administered to individuals 3 years of age and older, for intramuscular use
• 90687 -- Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
• 90688 -- ...when administered to individuals 3 years of age and older, for intramuscular use

To read the AMA's complete announcement, visit www.ama-assn.org/resources/doc/cpt/vaccine-codes.pdf.