Pulmonology Coding Alert

You have until December 31 to submit your 90658 claims.

Beginning Jan. 1, you can forget about the influenza vaccine code 90658 for your Medicare billing purposes. The code, which establishes separate billing codes for each brand-name influenza vaccine product, will give way to five specific HCPCS codes to meet your flu vaccine coding needs.

Fact: The new HCPCS codes cover Medicare payment effective for dates of service on or after October 1, 2010, which means that for dates of service between October 1 and December 31, 90658 and the Q codes will be valid for billing. Medicare defines the HCPCS codes as:

However, "effective for claims with dates of service on or after January 1, 2011, 90658 will no longer be payable for Medicare," according to a news release published by CMS in November. In other words, Medicare will not recognize these HCPCS codes until January 1, when 90658 will no longer be in effect.

Example: Your pulmonologist administers the flu vaccine to a patient on October 29. You may either bill Medicare immediately using 90658, or hold the claim and wait until January 1, 2011 to bill Medicare using the appropriate Q code.

In this case, make sure you have not submitted any claim using 90658. If so, you should not use the Q code for that same service, or you would be guilty of duplication.

Note: Use these codes only for vaccine that contains preservative (typically manufactured in multi-dose vials). If your practice administers preservative free vaccine (typically supplied in pre-filled single-dose syringes), continue to report 90656. Intranasal administration requires reporting of 90660. (Additionally, don't forget to report the appropriate administration code).