Pulmonology Coding Alert

CMS offers new guidance on billing for the vaccine and the administration

Effective Oct. 1, you'll be able to use diagnosis code V06.6 (Streptococcus pneumoniae [pneumococcus] and influenza) on claims you submit when a patient visits your office for both the pneumococcal pneumonia and influenza vaccines.
 
"You should 90658 (Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use) for the influenza vaccine and 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use) for the pneumococcal vaccine," says Alan L. Plummer, MD, professor of medicine, Division of Pulmonary, Allergy, and Critical Care at Emory University School of Medicine in Atlanta.

How it works: When a patient receives both influenza virus and/or PPV vaccines and you bill for their administration, report diagnosis code V06.6 on your claim. This instruction allows you to report V06.6 in place of both V03.82 (Streptococcus pneumoniae [pneumococcus]) and V04.81 (Influenza) if the patient came in to receive both vaccines.

Unchanging guidance: Continue reporting diagnosis code V03.82 on claims that contain only the PPV vaccine and its administration. Also, you should continue reporting diagnosis code V04.81 on claims that contain only the flu vaccine and its administration.

Remember: Make sure you code the administration of the vaccine on your claim. Use G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day) to bill Medicare for the flu shot administration. For the administration of the pneumonia vaccine to a Medicare beneficiary, use G0009 (Administration of pneumococcal vaccine when no physician fee schedule service on the same day).

Bonus: Your Medicare carriers now have to accept 90660 (Influenza virus vaccine, live, for intranasal use) for the administration of the intranasal flu vaccine, Flumist. "Medicare is also allowing for payment of intranasal influenza (90660)," says Cheryl Scott, CPC, CPC-H, CCS, CCS-P, coding consultant with the Health Texas in Dallas. "The administration of the intranasal flu vaccine should still be reported with G0008."

What it means to you: The instructions from CMS are pretty straightforward, so as long as you update your billing process and superbill so you're using V06.6, you should have no trouble getting paid on flu shot and pneumonia vaccine services.

"If you follow the guidelines, you shouldn't have any issues," says Lisa Center, CPC, coder with Mount Carmel Regional Medical Center in Pittsburg, Kan.