Pulmonology Coding Alert

Hint: Use the same system for reporting H1N1 vaccinations.

Come October, practices will begin gearing up for a new flu season. You could end up with an epidemic of ailing influenza vaccine claims if you miss four key pointers.

1. Check Vaccine Type

The first step to accurate flu vaccination reporting is to check for the presence or absence of preservative to arrive at the right code. The next key is to look at the age of the patient who is receiving the flu shots.

Based on the type of vaccine, age of the patient and mode of administration, you can then choose from one of the following codes:

• 90655 -- Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
• 90656 -- Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
• 90657 -- Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use
• 90658 -- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use
• 90660 -- Influenza virus vaccine, live, for intranasal use
• 90661 -- Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
• 90662 -- Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use

Note: These above mentioned codes are for seasonal flu vaccines used by your pulmonologist. If your pulmonologist is using a pandemic formulation, choose from CPT® codes 90664-90668 (Influenza virus vaccine, pandemic formulation...) depending on the type of vaccine used.

2. Look at Vaccine Brand For Medicare Patients

If your pulmonologist is providing the influenza vaccine to a Medicare patient, you will have to look specifically into the brand of vaccine as reimbursement is different, depending on the vaccine used. So when reporting the vaccine for Medicare patients, you should choose from the following codes:

• 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 -- [...not otherwise specified]

3. Choose Appropriate Administration Codes For Different Payers

"The HCPCS code G0008 (Administration of influenza virus vaccine) must still be used for the administration of the flu vaccine for Medicare patients," says Mary I Falbo, MBA, CPC, President of Millennium Healthcare Consulting, Inc., Lansdale, PA. You will have to use G0008 to report the administration in addition to reporting the vaccine used. "If the Medicare beneficiary receives both a flu shot and a pneumovax, use administration code G0008 for the flu shot and G0009 (Administration of pneumococcal vaccine) for the administration of the pneumovax, along with the appropriate pneumococcal vaccine code," says Alan L. Plummer, MD, Professor of Medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.

When reporting influenza vaccine administration to other insurance payers, you will have to choose from the following set of CPT® codes depending on the number of injections and route of administration:

• 90471 -- Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
• +90472 -- ...each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
• 90473 -- Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
• +90474 -- ...each additional vaccine [single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

Note: When your pulmonologist provides these vaccines to persons below the age of 18, choose 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered) for one vaccine and +90461 for additional vaccines.

Reminder: Don't forget to report diagnosis codes V04.81 (Need for prophylactic vaccination and inoculation against influenza) when your pulmonologist provides flu shots and V06.6 (Need for prophylactic vaccination and inoculation against streptococcus pneumoniae and influenza) when both influenza and pneumococcal vaccines are provided.

4. Check Payer Preference For H1N1 Vaccine Administrations

As of Jan.1, 2012, the codes that were created for H1N1 vaccines (90663) and administration (90470) stand deleted. H1N1 is no longer considered a pandemic and seasonal vaccines contain a component for protection against H1N1. So when your pulmonologist provides vaccination against H1N1, you have to use the same vaccine codes and administration codes as you would use for seasonal flu vaccines.

However, when reporting a H1N1 vaccine for Medicare patients, you can use the following G codes:

• G9141 -- Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
• G9142 -- Influenza a (H1N1) vaccine, any route of administration

"Some third-party payers are requiring these codes instead of the CPT® codes to report the H1N1 vaccine serum and administration," adds Falbo. So check with the payer to know preference to report vaccination for H1N1 administration.