Pulmonology Coding Alert

You won't find two newly released codes for swine flu vaccinations in CPT Codes 2010, which makes deciding which codes to use nothing to sneeze at.

The following codes were approved after CPT 2010 went to press and are effective immediately:

These new codes have been issued on an accelerated schedule to help ease the pressures of this year's unusual influenza season and will help to streamline the reporting and reimbursement procedures in administering nearly 200 million doses of the H1N1 vaccine in the U.S. They will also help to efficiently report and track immunization and counseling services related to the vaccine.

"Remember to bill 90663 for $0 since the vaccine is provided free of charge by the federal government," says Alan L. Plummer, MD, professor of medicine in the division of pulmonary, allergy, and critical care at Emory University School of Medicine in Atlanta. "Providers will be paid for H1N1 vaccine administration (90470) and will have to check with each carrier to determine which codes to use."

For Medicare, if you're planning to administer the vaccination for H1N1, also known as the swine flu, the odds of collecting for the vaccine administration just improved.

On Aug. 28, CMS released MLN Matters article MM6617, which introduces two new codes that apply to the H1N1 vaccine, as follows:

• G9142 -- (Influenza A [H1N1] vaccine, any route of administration) is the code for the vaccine;

• G9141 -- (Influenza A [H1N]) immunization administration [includes the physician counseling the patient/family]) refers to the vaccine administration.

Remember: Because the H1N1 vaccine is available to providers free of charge, you should not bill Medicare for the vaccine -- only for the administration, said CMS's Stewart Streimer during an Aug. 25 CMS Open Door Forum.

"Providers should report one unit of HCPCS code G9141 for each administration of the H1N1 vaccine," the MLN Matters article notes.

Payment: CMS intends to pay you the same amount for G9141as it reimburses for G0008 (Administration of influenza virus vaccine) and G0009 (Administration of pneumococcal vaccine).

"The reimbursement varies by state, but ranges from about $18 to $25," says Atlanta-based coding consultant Jay Neal.

You can find your state's rate at: www.cms.hhs.gov/AdultImmunizations/Downloads/AdminRates09.pdf.

Bonus: Although Medicare normally pays for just one vaccination per year, it will pay for both a seasonal flu vaccine (G0008) and an H1N1 vaccine if both are medically necessary, according to a Sept. 2 e-mail from CMS to all fee-for-service providers.

The AMA is actively monitoring the most salient clinical information and recommendations on the flu and providing physicians with easy access to those sources for clinical use and communication with patients. The AMA's current advice to physicians is:

• Antiviral treatment should be considered for high risk individuals with suspected influenza and said treatment should be started empirically.

• Pregnant women are the most vulnerable and should be vaccinated with inactivated vaccine.

• All healthcare workers should be vaccinated; LAIV (intranasal spray) is perfectly fine for use in healthcare workers.

Note: For up-to-date information and resources, tailored for physicians, on seasonal and 2009 H1N1 influenza, visit www.amaH1N1info.org.