Pulmonology Coding Alert

CPT 2004 deletes whole-virus code Although coding influenza vaccinations may seem straightforward, pulmonology coders could run into reimbursement trouble if they use 90659 in 2004 because CPT deletes the whole-virus influenza code.

When reporting the pulmonologist's influenza vaccination services, coders should choose from 90658, G0008 and 90471, depending on the payer. Here's how: Bill for Injection and Supply Typically, the patient's insurer determines the codes you'll use to report flu shots and vaccination supply. When billing a Medicare carrier for flu vaccinations, report G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day). You may report G0008 in addition to the immunization code 90658 (Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use). If a private carrier covers that patient or if the insurer doesn't follow Medicare guidelines, assign administration code 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) for the flu injection. Also, you can bill for the vaccine supply, using 90658, because 90471 does not include payment for injected material. Remember that you can no longer report 90659 (Influenza virus vaccine, whole virus, for intramuscular or jet injection use) to any carrier. CPT deleted the code because companies don't manufacture the whole-virus vaccine anymore. To medically justify flu vaccination shots, link ICD-9 code V04.81 (Need for prophylactic vaccination and inoculation against certain viral disease; influenza). Report Flu and Pneumonia Shots Together What should you do if the nurse gives a patient a flu and pneumonia vaccine injection (G0009, Administration of pneumococcal vaccine when no physician free schedule service on the same day) on the same date of service? If you're reporting to Medicare, assign G0008 (... influenza...) and G0009, says Renee Brown, CPC, Southeastern Lung Care, Conyers, Ga. You should report the vaccine with code 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use), coding experts say. For private insurers, you should report add-on code +90472 (... each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]) in addition to 90471. And don't worry about attaching modifier -51 (Multiple procedures) - never attach modifiers to add-on codes, because they represent physician services that are additional portions to other primary procedures. Also in this case, use 90732 for the vaccine. New Vaccine Requires 90473 For some private insurers, you may bill for the new intranasal flu vaccine using a nonintramuscular immunization code. The Food and Drug Administration recently licensed the intranasal flu vaccine FluMist, says Richard H. Tuck, MD, FAAP, a nationally recognized speaker on [...]