Primary Care Coding Alert

Question: I have trouble keeping all the flu vaccine coding combinations straight. Do you have any suggestions?


Maine Subscriber
Answer: With some family physicians receiving new shipments of influenza vaccines, you still need to know how to code these encounters. To identify the correct administration and product code, take these actions:

1. Bill the administration: You can submit flawless claims for influenza vaccine administration if you look at the service's details--patient's age and insurer and physician counseling--and the administration route--injection or inhalation. Match these specifics with the following administration codes: 

2. Add the vaccine product code:

- Fluarix--90656
- FluMist (only inhaled product)--90660
- Fluvirin influenza virus vaccine--90658
- Fluvirin preservative-free pre-filled syringe--90656
- Fluzone influenza virus vaccine: for children 6-35 months of age--90657 for persons 3 years of age and older--90658
- Fluzone preservative-free pediatric dose, influenza virus vaccine--90655. 3. Enter the diagnostic link: V04.81 (Need for prophylactic vaccination against influenza). Note: If the FP performs and documents a significant and separately identifiable E/M service from the immunization service, you should report an E/M code, such as 99201-99215 (Office or other outpatient visit for the evaluation and management of a new or established patient) appended with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service).