Primary Care Coding Alert

How to Code This Season's Influenza Prevention

Question: A nurse administered a flu shot to a patient. What is the proper way to bill the product and the administration?

Connecticut Subscriber

Answer: Depending on the product and patient, you should assign one of four influenza vaccine codes (90655-90658) and one of three administration codes (90471, 90473, G0008).

Product: When the patient is under 3 years of age, you'll use one of two codes. For Fluzone Preservative-Free Pediatric Dose, Influenza Virus Vaccine (Aventis Pasteur), bill 90655 (Influenza virus vaccine, split virus, preservative free, for children 6-35 months of age, for intramuscular use).

If the nurse administers the nonpreservative-free vaccine, Fluzone Influenza Virus Vaccine (Aventis Pasteur), you should bill 90657 (Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use).

For adult patients (over 3 or 4 years of age), you will probably report either 90656 (Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years of age and above, for intramuscular use) or 90658 (Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use). Code Chiron's Fluvirin Preservative-free Pre-filled syringe with 90656. For Fluzone Influenza Virus Vaccine (Aventis Pasteur) or Fluvirin Influenza Virus Vaccine, report 90658.

Prior to 2004, physicians rarely used the live-virus vaccine (90660, Influenza virus vaccine, live, for intranasal use). But with this year's Fluvirin shortage, many practices may offer the inhaled flu vaccine FluMist (MedImmune Inc.). Because MedImmune makes this vaccine from live influenza virus, you should report FluMist as 90660.

Administration: You should report intramuscular injection administration with 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]), unless the nurse gives the shot to a Medicare patient. For Flumist, use 90473 (Immunization administration by intranasal or oral route; one vaccine [single or combination vaccine/toxoid]) with 90660. Medicare requires you to report flu administration with G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day).

Bonus: Family Practice Coding Alert's reimbursement tip sheets ensure you submit flawless administration and vaccine claims. The injection and intranasal charts guide you through an injection service's three easy steps. They even include an alphabetical list of what vaccine code to report for the five influenza immunization products. To obtain your free flu shot charts, e-mail jgodreau@medville.com.