Primary Care Coding Alert

Follow these do's and don'ts when you report two Fluzone products

If you aren't sure how you'll bill for the new intramuscular (IM) influenza vaccine without a specific CPT code, you'll be glad to hear that you can report a CPT 2004 code for this product. Read how coding experts recommend using 90655 to get pediatric Fluzone paid.
  
Although the Food and Drug Administration (FDA) approved Fluzone last year, no CPT code existed for the pediatric (under 3 years old) toxoid, which was not widely available. But starting on or after Nov. 15, 2003, you should use a new CPT 2004 code for Aventis Pasteur's Fluzone Subvirion (pediatric version), says Richard H. Tuck, MD, FAAP, a nationally recognized speaker on coding, compliance and reimbursement.
 
Before submitting your Fluzone claim - pediatric or adult dosage - make sure you run through your list of do's and don'ts:

Do use 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) for non-Medicare Fluzone administration.

Do bill flu vaccine administration to Medicare patients with G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day).

Do report the pediatric IM vaccine product with 90655 (Influenza virus vaccine, split virus, preservative-free, for children 6-35 months of age, for intramuscular use).

Do check with insurers before using CPT 2004 code 90655. Some payers will accept the new code retroactive to Nov. 15, 2003. Others may not implement the 2004 code until the beginning of the year.

Do submit 90749 (Unlisted vaccine/toxoid) this fall to insurers that don't recognize 90655 until 2004.

Do bill for the adult Fluzone product with 90656 (Influenza virus vaccine, split virus preservative-free, for use in individuals, 3 years of age and above, for intramuscular use). Although this code is valid for reporting as of Nov. 15, 2003, 90656 won't appear in CPT until 2005.

Don't send 90749 alone. Include a vaccine description, a copy of the Fluzone package insert, and the manufacturer's letter.

Don't use 90655 for Fluzone Zonal Purified (the adult product).

Don't assign G0008 with 90655. Pediatric patients rarely qualify for Medicare, and G0008 is a Medicare administration code.

Don't waste time searching the Web. For more information, visit www.ama-assn.org/ama/pub/category/10902.html or www.ama-assn.org/ama1/pub/upload/mm/36/aug_15_update_word.doc.