Pediatric Coding Alert

Check out the handy chart to help you keep it all straight.

Flu season is officially here, which means new vaccines, new codes, and new recommendations. This season, physicians are able to choose from up to nine different flu vaccines. No matter how many flu vaccines your practice performs in the coming months, you’ll want to update your flu vaccine know-how.

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

Take Note of New Vaccine Compositions

As is consistent with recent years, all flu vaccines for the 2023-2024 season will be quadrivalent (four-component). Similar to last year, 91 percent will be thimerosal-free or thimerosal-reduced vaccines, and about 21 percent of flu vaccines will be egg-free.

Notice New Egg Allergy Recommendations

In previous years, the Advisory Committee on Immunization Practices (ACIP) recommended that people with severe egg allergies get their vaccinations in an inpatient or outpatient medical setting. While they recommend that all vaccines be given where allergic reactions can be recognized and treated promptly, for this 2023/2024 season, they are not recommending additional safety measures for people with egg allergies, regardless of the severity of any previous reaction to egg. In other words, anyone with any history of egg allergy, regardless of severity, may receive any influenza vaccine that is age- and health-appropriate.

“This recommendation change will be welcome relief for clinicians required to carefully maintain separate vaccine supplies for allergic patients,” says Jan Blanchard, CPC, CPEDC, CPMA, pediatric solutions consultant at Physician’s Computer Company in Winooski, Vermont. “The labor and storage expenses for vaccine inventory tracking and reconciliation are poorly paid as it is. Every little bit of time saved in this crucial preventive care is a gain,” she continues.

Know Which Vax Codes to Not Report

Pediatricians don’t see patients 65 years and older, so pay close attention to not mistakenly report the following codes:

• Fluzone High-Dose Quadrivalent 0.7 mL pre-filled syringe, reported using 90662 (Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use)
• Fluad Quadrivalent 0.5 mL pre-filled syringe, reported using 90694 (Influenza virus vaccine, quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use)

The following code is assigned to a product reserved for patients greater than 18 years:

• Flublok Quadrivalent 0.5 mL pre-filled syringe, reported using 90682 (Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use)

Realize Absence of 0.25 mL Pre-Filled Fluzone

Fluzone Quadrivalent (approved for children aged 6-35 mo. at either 0.25 mL or 0.5 mL per dose) is no longer available in 0.25 mL prefilled syringes. Therefore, you’ll need to code 90686 (Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use) if the child in this age group receives the higher dose from the pre-filled syringe.

Check Out This Covid Guidance

The ACIP says that “inactivated and recombinant influenza vaccines may be administered concurrently or sequentially with other live or inactivated vaccines.” In other words, the clinician can administer the live attenuated flu vaccine simultaneously with other inactivated or live vaccines. However, “if two live vaccines are not given simultaneously, then administration of a live attenuated influenza vaccine and another live vaccine should occur at least four weeks apart,” ACIP advises.

The ACIP also recommends that clinicians defer influenza vaccination for those patients who are moderately or severely ill until they recover. They say that clinicians can use their judgment whether to defer flu vaccination for people with mild COVID-19 symptoms or who are asymptomatic.