Pediatric Coding Alert

Purchased product pay remains the same.

If a recent bulletins got you scared that a major insurer will end 90476-90749 coverage, stop worrying.

Key: The childhood immunization protocol applies only to Medicaid patients. Your current reimbursement from UnitedHealthcare for immunizations remains unchanged, UHC stressed in a February Nevada Medicaid memo.

The release responded to concerns caused by UHCs January 2009 bulletin, which led some coders to think that the insurer is no longer covering immunizations. Practices would have to use VFC product and bill the insurer for the administration using modifier SL (State supplied vaccine).

UHC-Run Medicaid Programs Require 2 Codes

In some states, a commercial plan, such as UHC or Blue Cross, contracts for the Medicaid plan, explains Christine Newman, office manager at Oyster Bay Pediatrics in New York.

Under the UHC Medicaid programs, when a Medicaid patient receives a VFC product, you bill the administration(90465-+90474) with modifier SL to UHC at the allowed rate. Then, you have to submit the appropriate codes to the health plan for all vaccines administered, according to UHCs bulletin. In other words, you report the product code (90476-90749) at $0.00.

Expect more commercially-run Medicaid plans to come out with similar protocols. State Medicaid programs are under fire to show quality of care parameters, explains Charles Scott, MD, FAAP,pediatrician at Medford Pediatrics and Adolescents in New Jersey. Because of state supplied VFC vaccines, and equally because of extremely poor admin payments, doctors may not be sending in the data -- or may only be submitting for the admin codes and not identifying which vaccines have actually been given.

Smart: To bill vaccines when you should, mark your charts to indicate the immunization supply, such as Medicaid or United/Commercial. We use neon green stickers on the vaccine record sheet to highlight the state insurance patients, Newman says.