Pediatric Coding Alert

Just when you thought you had grasped the CPT Codes 2003 changes that affect pediatrics, CMS reverses its decision to establish new hepatitis B vaccine HCPCS Q codes (Q3021-Q3023) and reactivates the CPT versions (90740-90747).

CMS issued transmittal AB-02-185 on Dec. 31, 2002, which rejected three 2003 HCPCS Q codes:

You should continue to report CPT codes 90740 (Hepatitis B vaccine, dialysis or immunosuppressed patient dosage [3 dose schedule], for intramuscular use), 90743 (Hepatitis B vaccine, adolescent [2 dose schedule], for intramuscular use), 90744 (Hepatitis B vaccine, pediatric/adolescent dosage [3 dose schedule], for intramuscular use), 90746 (Hepatitis B vaccine, adult dosage, for intramuscular use) and 90747 (Hepatitis B vaccine, dialysis or immunosuppressed patient dosage [4 dose schedule], for intramuscular use) for these vaccines.

Although Medicare will accept 90740-90747 starting Jan. 1, 2003, carriers will not accept the codes until April 1. For claims containing only hepatitis B vaccine codes with dates of service Jan. 1-March 31, you should hold the claims in your system and submit them in April. For claims containing additional services furnished on the same date, you may remove the vaccine charge and then submit an adjustment bill in April to receive payment for the vaccine CPT code. This way you can still receive prompt payment for the other services.

CMS designates Q codes as temporary codes to see how they work. When CPT assigns a permanent code for the procedure, service or supply, HCPCS eliminates the Q code.

In the case of the hepatitis codes, no new code replaces the Q codes. Rather, CMS reverts to the more specific CPT vaccine coding, which requires dose schedules and the type of patient. The Q codes would have eliminated the schedule and would have been based on the type of patient (age or immunosuppressed). The American Academy of Pediatrics committee on coding and nomenclature helped win the reversal in an effort to keep coding understandable.