Pulmonology Coding Alert

Due to the shortage of flu vaccinations, some pulmonologists are just receiving their supplies along with the bill. Manufacturing delays postponed delivery as much as two months in some areas. I think its fair to say that things have gone more smoothly in most years in the past, says Steven Black, MD, co-director of the Kaiser Permanente Vaccine Study Center in Oakland, Calif. How do physicians code and set the fee so they can get properly reimbursed for the flu shot? Do patients need to sign a waiver so that if Medicare doesnt cover the cost, they will be responsible?

According to HCFA, every year pneumonia and flu take the lives of 40,000 to 70,000 Americans more than all other vaccine-preventable diseases combined. Some 90 percent of these deaths are in the Medicare population.

Coding for the Vaccination

Code 90471 (immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections and/or intranasal or oral administration]; one vaccine [single or combination vaccine/toxoid]) and the add-on code 90472 (each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]) must be reported in addition to the vaccine and toxoid codes 90476-90749, which identify the vaccine product only.

When coding flu vaccinations, pulmonologists should use the diagnosis code V04.8. To report the proper vaccine product, there are three codes: 90657 (influenza virus vaccine, split virus, 6-35 months dosage, for intra-muscular or jet injection use), 90658 (influenza virus vaccine, split virus, 3 years and above dosage, for intramuscular or jet injection use) and 90659 (influenza virus vaccine, whole virus, for intramuscular or jet injection use). The administration of influenza virus vaccine is G0008 (administration of influenza virus vaccine when no physician fee schedule service on the same day).

For pneumonia, use 90732 (pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for subcutaneous or intramuscular use). Use G0009 (administration of pneumococcal vaccine when no physician fee schedule service on the same day) to code the administration. Diagnosis code V03.82 (need for prophylactic vaccination and inoculation against pneumococcus pneumoniae) is used if the sole purpose for the visit is to receive the vaccine.

When a physician sees a beneficiary for the sole purpose of administering an influenza or pneumonia vaccine, he or she may not routinely bill for an office visit. If a patient receives other services constituting an office visit level of service, however, the physician may bill for a visit and Medicare will pay if it is reasonable and medically necessary.

Keep in mind that G0008 and G0009 may be paid in addition to other services, including evaluation and management (E/M) services and are not subject to bundling. Medicare also will pay twice for the [...]