Pulmonology Coding Alert

Plus: Also watch out for these new options that won’t be in the CPT® book yet.

If newly introduced influenza vaccines such as the quadrivalent or the inactivated adjuvanated vaccines were creating coding dilemmas, you can now rest easy as CPT® 2013 has increased your coding options by creating new codes while making changes to some of the old ones. Read on for the latest news from the American Medical Association (AMA) and what changes you should be ready for.

Prepare for ‘Official’ and Revised Vaccine Codes

Several code changes will impact your reporting in 2013, affecting your influenza and hepatitis B vaccine administrations.

FDA ok: In CPT® 2012, code 90644 (Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine [Hib-MenCY], 4-dose schedule, when administered to children 2-15 months of age, for intramuscular use) included a lightning bolt symbol because it was awaiting FDA approval. The FDA approved the vaccine on June 14, so CPT® removed the "lightning bolt" indicator from the 2013 CPT® book and be aware that payers should reimburse the vaccine without any qualms.

Flu vaccine additions: Two new influenza immunization product codes were released in July 2012, and will become effective Jan. 1, 2013. Your new code choices will include 90653 (Influenza virus vaccine, inactivated, subunit, adjuvanated, for intramuscular use) and 90672 (Influenza virus vaccine, quadrivalent, live, for intranasal use). Note that the vaccine associated with 90653 is awaiting FDA approval.

Influenza vaccine codes 90655-90660 also get an update in CPT® 2013. Each descriptor will include the term "trivalent," meaning that the vaccine protects against three influenza viruses and that all three components are built into one vaccination.

Hepatitis changes: You’ll find one new and one revised code for hepatitis B vaccines in CPT® 2013. New code 90739 (Hepatitis B vaccine, adult dosage [2 dose schedule], for intramuscular use) will go into effect on January 1 with a warning symbol that FDA approval is pending. In a related change, hepatitis B vaccine code 90746 will be revised to clarify that it represents a three-dose schedule.

Note These Codes You Can Use Before Printing

The CPT® Editorial panel announced four more influenza vaccine codes that will go into effect in 2013, though you won’t find them in your CPT® book until 2014. The new codes include:

• 90685 -- Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
• 90686 -- …when administered to individuals 3 years of age and older, for intramuscular use
• 90687 -- Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
• 90688 -- …when administered to individuals 3 years of age and older, for intramuscular use.

"These codes are essentially the quadrivalent version of codes 90655-90658," says Kent J. Moore, manager of healthcare delivery and finance systems for the American Academy of Family Practice (AAFP) in Leawood, Kan. "That’s why the word ‘trivalent’ was added to each descriptor."

Caveat: All four codes currently are pending FDA approval (as seen by the lightning bolt symbol associated with them in AMA materials). "The codes probably shouldn’t be used until FDA approval or on January 1, 2013, whichever comes later," Moore advises.

Don’t Drop To-Be-Deleted Codes Yet

The AMA announcement also included details on vaccine codes that won’t be part of CPT® 2013, primarily because of changing clinical indications. The three codes that will be eliminated from Jan.1, 2013 include:

• 90718 -- Tetanus and diphtheria toxoids adsorbed when administered to individuals 7 years or older, for intramuscular use
• 90665 -- Lyme disease vaccine, adult dosage, for intramuscular use
• 90701 -- Diphtheria, tetanus toxoids, and whole cell pertussis vaccine (DTP), for intramuscular use.

"The CPT® Editorial Panel does attempt to keep this section of the book as current as possible to reflect current clinical practice," Moore says. "Deleting codes, where appropriate, is part of that process."

Remember, however, that you can still report the codes for services provided through the end of 2012. A note on the AMA’s website supports this stance, reading, "It is important to note that these codes remain effective for reporting through December 31, 2012."

If your payer is already denying claims for these services before the codes are dropped in 2013, send a copy of the AMA’s clarification with your appeal to ensure payment for your vaccine services. You’ll find the complete announcement at www.ama-assn.org/resources/doc/cpt/vaccine-codes.pdf.