Pediatric Coding Alert

Older-patient codes. For patients who are 3 years old and older, you will report:
 

Exception: The only time that you don't have to pay attention to a child's age is when you use an intranasal vaccine rather than an intramuscular injection. Whenever you use the inhaled influenza virus vaccine, you should report the product with 90660 (Influenza virus vaccine, live, for intranasal use).
 
Why: Code 90660's descriptor, "for intranasal use," specifies an inhaled product.

2. Check the Vaccine Type

You should next look at the type of influenza immunization product you use.
 
CPT splits influenza vaccines into two major groups: split virus products and live vaccines. You inject split virus products, but have the patient inhale a live vaccine. Four codes (90655-90658) describe split virus flu-shot product, and one code (90660) specifies a live, inhaled vaccine.
 
Key words: To determine which intramuscular vaccine code you should use, check whether the product is "regular" or preservative-free.
 
Depending on the child's age, you should report 90655 or 90656 for a preservative-free vaccine. When you give a regular influenza shot, assign 90657 or 90658. CPT designates specific codes for regular and preservative-free flu immunizations, because preservative-free vaccines cost more.
 
Due to this year's flu-vaccine shortage, your office may use multiple intramuscular products for each age group. "We usually use Aventis Pasteur's regular Fluzone," Davis says. "This year, although we haven't given any yet, we'll also administer Aventis' thimerosal-free product."
 
(For how to code Fluzone products, see "CPT Contains 3 Fluzone Vaccine Codes" this issue.)

Codes 90656, 90658 Start Earlier Than Fluvirin Use Does

Chiron also makes a preservative-free product named Fluvirin Preservative-free Pre-filled syringe. When you give Chiron's pre-filled syringe shot, you should report the vaccine as 90656.
 
Hidden problem: Don't worry that Chiron's preservative-free flu vaccine and product code 90656's age designation don't match up exactly. Even though 90656 starts at 3 years of age, the FDA approves preservative-free Fluvirin for children 4 years of age and older.
 
The same discrepancy exists with regular Fluvirin, which you should code with 90658. The FDA approves Fluvirin for use in children 4 years of age and older. The code descriptor that you use starts at age 3.
 
This problem, however, doesn't occur every time you use 90658. You'll also assign the code when you use Aventis Pasteur's regular Fluzone in children 3 years and older.

Report FluMist Administration With 90660

Reminder: When you administer an intranasal product, you should report 90660. "The intranasal flu vaccine uses a live vaccine," Palmer says.
 
Practices rarely gave the inhaled influenza immunization, FluMist, last year because the product was not readily available. But both Davis and Palmer plan on giving the intranasal vaccine to alleviate the vaccine shortage.

3. Report Administration Code

After you select the product code, you should bill for the vaccine's administration.
 
For 2004 claims, you should report intramuscular injection administration with 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid) or +90472 (... each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]).

If you administer a flu shot as the primary intramuscular vaccine, use 90471. Report influenza immunization as an additional vaccine administration with 90472.
 
For intranasal vaccines, use 90473 (Immunization administration by intranasal or oral route; one vaccine [single or combination vaccine/toxoid]) or +90474 (... each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]). If you administer FluMist as the primary intranasal vaccine, assign 90473. When you give the inhaled flu immunization as an additional vaccine, report 90474.

In 2005, You Can Also Code for Prevaccine Counseling

Starting Jan. 1, you should also check whether the pediatrician provides vaccine counseling. If he does, and the patient is under age 8, you should use the new pediatric-specific immunization administration (PSIA) codes.
 
You should report a flu-shot administration with 90465 (Immunization administration under 8 years of age [includes percutaneous, intradermal, subcutaneous, or intramuscular injections] when the physician counsels the patient/family; first injection [single or combination vaccine/toxoid], per day) or 90466 (...  each additional injection [single or combination vaccine/toxoid], per day [list separately in addition to code for primary procedure]).
  
If you give the shot as the primary intramuscular injection, use 90465. Or if you give it as an additional vaccine, assign 90466.
 
For an intranasal influenza vaccine administration, you should use 90467 (Immunization administration under age 8 years [includes intranasal or oral routes of administration] when the physician counsels the patient/family; first administration [single or combination vaccine/toxoid], per day) or 90468 (... each additional administration [single or combination vaccine/toxoid], per day [list separately in addition to code for primary procedure]) based on these guidelines:

 

4. Enter the Diagnosis

No matter which vaccine product you use or which administration you perform, you should use one ICD-9 code. For all influenza vaccinations, you should report V04.81 (Need for prophylactic vaccination against influenza), Davis says.