Pediatric Coding Alert

And reference the clip-and-save chart for quick coding.

It’s flu season again, which means your clinic’s flu vaccine administration is probably starting to ramp up. Whether your practice does just a handful of these, or you operate regular flu vaccination clinics, you’ll want to update your flu vaccine know-how.

Here is everything you need to know about codes, guidelines, and recommendations to get you through the winter months.

Continue to Ignore Trivalent Vaccine Codes

The Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP) recently published its updated recommendations for, and continued guidance on, flu vaccinations. Consistent with last year’s recommendations, the ACIP announced “all flu vaccines for the 2022-2023 season are quadrivalent vaccines, designed to protect against four different flu viruses, including two influenza A and two influenza B viruses.” This season, you’ll only choose from the quadrivalent vaccine codes listed in the clip-and-save table appearing later in this article.

Note: If you think back to last year, you’ll remember that two CPT^® quadrivalent codes — 90630 (Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use) and 90688 (Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use) — were not in play. This year, you’ll need to bring 90688 back into your coding arsenal.

Notice New Vaccine Compositions

As you’ve seen in most years prior, the CDC has changed the composition of the available quadrivalent vaccines. While no changes were made to the A(H1N1)pdm09 components this year, the recommended A(H3N2) component was updated.

Also, 93 percent of this season’s vaccines are thimerosal-free or thimerosal-reduced, and approximately 20 percent are egg-free.

Know the 3 Vaccines for Patients 65 Years and Older

While pediatricians don’t see patients ages 65 and older, you’ll need to pay close attention to which codes you won’t likely report at your practice:

• 90662 (Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use)
• 90682 (Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use)
• 90694 (Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use)

Coding alert: As you can see from the clip-and-save, 90682 is approved for anyone 18 years of age and older. You may still have occasion to report this code.

Check Out Updated Flucelvax Quadrivalent Age Approval

As the clip-and-save also indicates, both 90674 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use) and 90756 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use) are now appropriate for children ≥ 6 months of age. This comes approximately one year after the vaccine approval age was changed from 4 through < 18 years to ≥ 2 years.

Expect a Lack of Pre-Filled Afluria

You might not find pre-filled Afluria Quadrivalent flu shots for children this year. The vaccine itself is available but may require that the recommended dose come from a multidose vial.

Observe This COVID Guidance

The ACIP continues to say “OK” to providers co-administering an influenza vaccine with a COVID-19 vaccine if the patient is “eligible and the timing coincides.” They are not recommending patients purposely wait to get their COVID-19 or flu vaccine for the purpose of simultaneous vaccination.

Remember Administration Codes

Make sure you add an immunization administration code from 90460/+90461 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional…), 90471/+90472 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) …), or 90473/+90474 (Immunization administration by intranasal or oral route …) as appropriate.

To view the full ACIP report, go to https://www.cdc.gov/vaccines/hcp/acip-recs/index.html

*May not be available