Primary Care Coding Alert

And use this handy clip-and-save chart to code all your quadrivalent flu vaccines.

Flu vaccination season is in full swing, and the Centers for Disease Control and Prevention (CDC) has predicted “an early and possibly severe flu season” thanks to “reduced population immunity due to lack of flu virus activity since March 2020” (Source: www.cdc.gov/flu/season/faq-flu-season-2021-2022.htm).

 So, whether your practice administers vaccines to a handful of your patients or operates a full-blown flu vaccination clinic, you need to update your knowledge of flu vaccination guidelines and recommendations now.

Here’s everything you need to know to get through the next few months.

First, Know What Hasn’t Changed

On Aug. 27, 2021, the CDC’s Advisory Committee on Immunization Practices (ACIP) published its updated recommendations for, and continued guidance on, flu vaccinations.

The good news is that “not a whole lot has changed for coding influenza vaccines and/ or administration,” says Donna Walaszek, CCS-P, billing manager, credentialing/coding specialist for Northampton Area Pediatrics, LLP, in Northampton, Massachusetts. The ACIP is still recommending “routine annual influenza vaccinations for all persons aged ≥ 6 months who do not have contraindications,” per the report.

Additionally, “ACIP makes no preferential recommendation for a specific influenza vaccine when more than one licensed, recommended, and age-appropriate vaccine is available.” So,your provider can continue to use whichever quadrivalent flu vaccine you ordered earlier this year.

But the ACIP has provided the following updates.

Change 1: Retire Trivalent Flu Vaccine Codes for Now

Beginning now, you can start to retire CPT^® codes 90654, 90655-90660, 90661, and 90673 (Influenza virus vaccine, trivalent …). That’s because the ACIP report announced that “all seasonal influenza vaccines expected to be available for the 2021–22 season are quadrivalent.”

So, for this season, you’ll choose from the quadrivalent vaccines listed in the clip-and-save table at the end of this article.

Note: Two other 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) — will not be in play for the 2021-2022 flu season.

Change 2: Note These New Vaccine Compositions

As they have done in previous years, the CDC has changed the composition of the available quadrivalent vaccines, updating the influenza A(H1N1)pdm09 and influenza A(H3N2) components.

Change 3: Change Flucelvax Quadrivalent Age Approval

As the clip-and-save chart shows, both 90674 and 90756 are now appropriate for children ≥ 2 years of age. This change occurred in March of 2021; prior to that, the vaccine was only approved for children 4 through <18 years of age.

Change 4: Observe This COVID Guidance

The ACIP sees no reason why your provider cannot co-administer an influenza vaccine with a COVID-19 vaccine at this time. However, the committee does recommend that your provider “should consult current COVID-19 vaccine recommendations and guidance for up-to-date information.”

Change 5: Check Out Changes to Pregnant Women, Children’s First Doses

This vaccination season, the ACIP has given the green light to vaccinating women in their third trimester “soon after [the] vaccine becomes available.” Children 6 months through 2 years needing two doses four weeks apart should also get their first dose “as soon as possible after [the] vaccine becomes available.” And nonpregnant adults should not get vaccinated early (before September) “unless there is concern that later vaccination might not be possible.”

Change 6: Abide by This Anaphylaxis Advice

The ACIP is also recommending that patients who have experienced a severe allergic reaction or anaphylaxis to various egg-based vaccines in the past should now receive their vaccinations “in an inpatient or outpatient medical setting under supervision of a provider who can recognize and manage a severe allergic reaction.” The ACIP is also now recommending providers “consider consulting with an allergist to help identify the vaccine component responsible for the reaction.”

And Don’t Forget the Following

1) While the vaccines haven’t changed that much, pricing has. That means “providers should make sure their practice has updated their charges associated with their privately supplied vaccines to ensure maximum reimbursement. They can refer to www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing or refer to their practice invoices to ensure cost reimbursement,” Walaszek advises.

2) 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.

“These are tiny codes that make up the thinnest sliver of our healthcare expense, yet they are what keep some practices alive,” observes Chip Hart, director of PCC’s Pediatric Solutions Consulting Group in Vermont and author of the blog “Confessions of a Pediatric Practice Consultant.”