Pulmonology Coding Alert

Question: I heard we can use G codes for Medicare H1N1 vaccination. What are they, and how should I use them?

Answer: Beginning Sept 1, 2009, Medicare has covered H1N1 virus vaccine for Medicare Part B beneficiaries as an additional preventive immunization service and the administration of the H1N1 vaccine. Per a recent CMS Transmittal (http://www.cms.gov/Transmittals/Downloads/R2071CP.pdf), you should continue to report this service using one of these codes:

• G9141 -- Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)
• G9142 -- Influenza A (H1N1) vaccine, any route of administration.

Tip: Make sure you report V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; other viral diseases; influenza) as your diagnosis. The payment will be similar to the administration of the seasonal influenza vaccine (G0008, Administration of influenza virus vaccine).

Warning: It's inappropriate to report an E/M service (such as 99201-99215, Office or other outpatient services) if the sole purpose of the visit was to administer the vaccine, according to Medicare guidelines.