Practice Management Alert

There are times you can bill an additional E/M service--we-ll tell you when

Question: Our office is going to have a flu shot clinic for patients. We also administer flu shots and intranasal flu vaccines during appointments. How should I bill for these various vaccines to ensure payment?

As flu season approaches, now's the time to sort out your flu immunization billing. Often offices administer the flu vaccine in just one immunization, but that doesn't mean billing for it is quite that simple. To ensure the claim's success, you need to know what type of influenza vaccine the doctor used with the patient, the patient's age, and the number of injections the doctor gave during the encounter.

Fight potential snafus on flu immunization claims by following these four steps to ensure claims success and proper reimbursement for the influx of flu vaccine services you-re sure to see this season. Step 1: Figure Out the Vaccine Type When choosing the proper codes to bill for flu immunizations, you-ll need two codes. The first is the vaccine code. Look at the vaccine label to determine whether you should report 90656 (Influenza virus vaccine, split virus, preservative-free, when administered to 3 years of age and older, for intramuscular use) or 90658 (Influenza virus vaccine, split virus, when administered to 3 years of age and older, for intramuscular use).

Caution: Make sure you-re checking the documentation and labeling for each vaccine. -Know whether you are providing true preservative-free vaccines- before choosing which code to submit, says Carol Pohlig, BSN, RN, CPC, ACS, senior coding and education specialist at the University of Pennsylvania department of medicine in Philadelphia.

Don't miss: If the physician or nurse administered the flu vaccine intranasally, don't turn to 90656 or 90658. Instead, bill 90660 (Influenza virus vaccine, live, for intranasal use). Step 2: Decide on an Admin Code The next code you-ll need to bill properly for flu vaccinations is the administration code, which tells the payer what work your staff performed. The trick is that you need to bill differently to Medicare and private payers.

If the flu immunization is the primary vaccine that your physician orders or if the patient receives the immunization during a flu shot clinic, bill private carriers with 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]).

Alternative: Sometimes the physician will administer the flu immunization along with another separately injected vaccine. In this case, for a private-insurance patient, you should bill +90472 (- each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]) to reflect the second immunization.

If the patient receives an intranasal vaccine, you should bill private payers with 90473 (Immunization administration by intranasal [...]