Pulmonology Coding Alert
Coding for Vaccines
Alabama Subscriber
Answer: Vaccinations such as influenza and pneumonia are reported with two codes, an administration and an immunization code. Guidelines for using administration codes will vary by carrier. Medicare carriers instruct you to use G0008 (administration of influenza virus vaccine when no physician fee schedule service on the same day) and G0009 (administration of pneumococcal vaccine when no physician fee schedule service on the same day). Some commercial carriers, such as Pennsylvania Blue Cross Blue Shield, may also require you to use these HCPCS codes when reporting the vaccine administration.
If your carrier does not accept these, use CPT codes. Code 90471 (immunization administration; one vaccine [single or combination vaccine/toxoid]) is reported when either the flu or pneumonia is given on one day. If both are given on the same day, report 90471 and 90472 (... each additional vaccine [list separately in addition to code for primary procedure]). The administration of both immunizations on the same day is reported this way because they are never given as a combined immuniz-ation, such as measles/mumps/rubella or diphtheria toxoid.
Report the vaccine in addition to the administration codes. This is done in the same manner regardless of the carrier. Choose the influenza codes (90657-90660) based on age, virus type and/or method of administration. Report the code that is most appropriate for the individual case.
The pneumonia vaccine is reported with 90669 (pneumococcal conjugate vaccine) or 90732 (pneumococcal polysaccharide vaccine, subcutaneous or intra-muscular use). Code 90669 has been approved by the FDA only for use with the pediatric population.
Reporting an E/M code such as 99211 (office or other outpatient visit) is inappropriate if the patient has only received an immunization. An E/M service can be reported in addition to the immunization codes only if it is separately identifiable from the vaccination.
For example, if the nurse administered a vaccination and instructed the patient on the associated side effects, a separate E/M service should not be reported. If the nurse also checked the patient's blood pressure and dealt with issues that were a part of the patient's plan of care for hypertension, then a separate and identifiable E/M service can be reported in addition to the immunization codes.
Some carriers may require you to append modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the original E/M service reported on the same day as a vaccination, so ask your local carrier for guidelines.
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