Pediatric Coding Alert

4 simple steps help you submit flawless immunization claims If you report all influenza-vaccine services alike, not only are you coding improperly but you could delay or jeopardize payment.
 
Because each flu inhalation or shot requires its own product, administration and diagnosis code, you may have trouble keeping the corresponding codes straight. But you can avoid mismatches and ensure prompt payment if you follow four easy steps: 1. Look at the Patient's Age 
 
When selecting the influenza vaccine injection-product code, you should choose the appropriate code from the 90655-90658 series based on the child's age, says Gena Davis, medical reimbursement specialist at Growing Up Pediatrics in Cornelius, N.C.
 
CPT divides influenza intramuscular immunization codes into two age groups. The first group starts at 6 months and runs through 35 months of age The second set of codes describes injections for individuals 3 years old and up. These code sets correspond to the appropriate influenza vaccine dose of 0.25 ml for children 6-35 months and 0.5 ml for individuals 3 years and older. 
 
No codes describe flu shots for children under 6 months old. "You can't give an influenza shot until an infant is 6 months old," says Bonnie Palmer, billing manager at Tots 'N' Teens Health Associates in Elgin, Ill.
 
Early-childhood set. When a patient is under 3 years old, you'll use one of two vaccine codes:
  90655 - Influenza virus vaccine, split virus, preservative-free, for children 6-35 months of age, for intramuscular use
  90657 - Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use. Older-patient codes. For patients who are 3 years old and older, you will report:
  90656 - Influenza virus vaccine, split virus, preservative-free, for use in individuals 3 years of age and above, for intramuscular use
  90658 - Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use. 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 [...]