Pulmonology Coding Alert

Question: How should I code flu or pneumonia shots administered on the same day as an office visit?

Washington Subscriber
 

Answer: You should use codes G0008 (Administration of influenza virus vaccine ...) or G0009 (Administration of pneumococcal vaccine ...) for Medicare. You can report 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]) and +90472 ( each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]) for most non-Medicare insurers. Also, code the office visit (99201-99215), depending on carrier coverage if its separately identifiable, i.e., the patient was coming in for more than just the vaccine.
 
Medicare provides influenza virus vaccine (90657-90659) coverage once a year in the fall or winter. CMS does not require for coverage purposes that a doctor of medicine or osteopathy order the vaccine. Medical necessity must be present, however.
 
Therefore, the patient may receive the vaccine upon request without a physicians order and without physician supervision. For instance, if a child under 3 years receives a flu shot, report 90657 (Influenza virus vaccine, split virus, 6-35 months dosage, for intramuscular or jet injection use). For a child 3 years and older, use 90658. For a full influenza virus vaccine, regardless of the patients age, you would use 90659. Medicare will pay once for 90669 (Pneumococcal conjugate vaccine, polyvalent, for children under five years, for intramuscular use) 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).