Pediatric Coding Alert

Immunization Alert:

Iron-Clad Way to Report FluMist, Fluzone

Published on Thu Oct 23, 2003

Prepare for flu vaccines with this combo

Wondering what to do about the new intranasal flu vaccine and the preservative-free intramuscular flu vaccine? Here's the answer: Our experts say you should code the nasal mist the same way you would code a nonintramuscular immunization, but you'll have to use CPT Codes 2004 codes for the IM product.

The Food and Drug Administration recently licensed and the American Academy of Pediatrics (AAP) just approved the new intranasal flu vaccine, FluMist, says Richard H. Tuck, MD, FAAP, a nationally recognized speaker on coding, compliance and reimbursement. If your pediatrician plans to offer FluMist, you should report the services using the following codes:

Administration: 90473, Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)

Product: 90660, Influenza virus vaccine, live, for intranasal use.

Although the FDA approved Fluzone last year, no CPT code existed for the pediatric (under 3 years old) toxoid, which was not widely available. But starting Nov. 15, you should use a new CPT 2004 code for Aventis Pasteur's Fluzone Preservative-Free, Tuck says. Complete coding for the IM immunization is:

Administration: 90471, Immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections); one vaccine (single or combination vaccine/toxoid)

Product:

90655: Influenza virus vaccine, split virus, preservative free, 6-35 months of age, for intramuscular use

90656: Influenza virus vaccine, split virus for use in individuals, preservative free, 3 years and above, for intramuscular use.

Make sure to check with insurers before using 90655. Some payers will accept the new code retroactive to Sept. 15. Others may not implement the 2004 code until the beginning of the year. In this case, you should submit 90749 (Unlisted vaccine/toxoid) with a vaccine description, Fluzone package insert copy, and manufacturer letter. For more information, visit www.ama-assn.org/ama/pub/category/10902.html or www.ama-assn.org/ama1/pub/upload/mm/36/aug_15_update_word.doc.