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Pulmonology Coding Alert

Reader Question:

Vaccine Policies

Published on Fri Feb 01, 2002

Question: We have a policy whereby we are unable to administer flu vaccines to patients with severe asthma. What is the current thinking on this, and how should we code flu vaccine and administration for these patients when the patient is seen for an E/M service to evaluate his asthma prior to administering the vaccine?

Alabama Subscriber

Answer: Contrary to widespread fears among patients and some doctors, flu shots are safe even for those with severe asthma, according to a study reported in the Nov. 22, 2001, issue of The New England Journal of Medicine. Because of this misconception, only about 10 percent of asthma patients get a flu shot each year.
 
For administration of the vaccine, use ICD-9 codes V04.8 (need for prophylactic vaccination against influenza) and 493.xx (asthma) (the fourth digit specifies type of asthma; the fifth digit specifies severity). Make sure the pulmonologist specifies what is meant by "severe," e.g., whether it is an acute attack. For example, acute exacerbation or status asthmaticus is identified through the fifth digit (493.x2 or 493.x1).
 
When reporting the administration of the flu vaccine to Medicare beneficiaries, you must report three codes:

 1. The diagnosis code (V04.8, for influenza) to demonstrate medical necessity 
 2. The CPT code that identifies the specific vaccine administered, e.g., 90658-90659
 3. The appropriate administration code (G0008, administration of influenza virus vaccine when no physician fee schedule service on the same day).

For non-Medicare carriers, report the following:

 
  • Diagnosis code (V04.8)
     
  • The CPT code that identifies the specific vaccine administered (90658-90659)
     
  • The administration code (90471). If the vaccine is provided with an E/M service, some carriers may reimburse for the vaccine only. Appending 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 E/M code may help reimbursement, but does not guarantee it. 

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