Pulmonology Coding Alert

Question: Our office is expecting a shipment of the Fluarix TIV influenza vaccine. When a nurse uses this product, what codes should I use?

Illinois Subscriber

Answer: There are three quick steps to coding this service:

Step 1: Check the patient's insurer to determine how you should report the immunization administration. For a non-Medicare patient, assign 90471-90472 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections] ...).
 
Assign 90471 (... one vaccine [single or combination vaccine/toxoid]) when your staff gives Fluarix as a single or initial vaccine.
 
If the patient is on Medicare, use G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day).
 
Step 2: Because Fluarix is preservative-free and adult-only, report the product with 90656 (Influenza virus vaccine, split virus, preservative-free, for use in individuals 3 years and above, for intramuscular use).
 
Step 3: Link both the immunization administration and the product to ICD-9 code V04.81 (Need for prophylactic vaccination and inoculation against other viral diseases; influenza).
 
Fluarix is a trivalent preservative-free inactivated influenza vaccine (TIV) that prevents type A and B influenza. The FDA recently approved the Glaxo-SmithKline intramuscular injection for adults 18 years of age and older.

Beware: Do not report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) when the patient only comes in for a flu shot. The nurse must provide an additional medically necessary service (e.g., medication education) in order to report 99211 in addition to the flu shot.