Primary Care Coding Alert

Question: If I am billing out a flu vaccination for a Medicare patient, what codes should I use for the encounter. Also, please let me know if I have to report an appropriate E/M code for the visit?

Missouri Subscriber

Answer: If you are reporting a flu vaccination for a Medicare patient, you will have to report the administration of the vaccine using the HCPCS code G0008 (Administration of influenza virus vaccine). Note that this only covers the administration of the vaccine and does not cover the supply of the vaccine.

For the vaccine supply, you will have to choose from one of the following appropriate CPT® or HCPCS Q codes depending on what exactly your FP administered to the patient:

• Q2035 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use [Afluria])
• Q2036 (…[Flulaval])
• Q2037 (…[Fluvirin])
• Q2038 (…[Fluzone])
• Q2039 (…for intramuscular use [not otherwise specified])

You should not automatically report an E/M code whenever your FP performs administration of a vaccine. If your clinician is only performing services such as brief history, checking the patient’s vitalsigns, and ruling out any contraindications to the administration of the vaccine, you should not report any E/M code for the encounter, since such minimal evaluation might be considered inherent in the administration of the vaccine.

You can report an E/M service in addition to the vaccine administration code if and only if the E/M service was significant and separately identifiable from the vaccine administration. If a significant and separately identifiable E/M service was performed, you report the appropriate E/M code with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended to it to show that the E/M service was distinct from the vaccine administration performed.