Pulmonology Coding Alert

Question: We currently have an onslaught of patients requesting flu vaccines and I am concerned that I may be confusing which vaccine and administration codes I should be using. Can you do a quick review of the codes and when to use them?

Texas Subscriber

Answer: There are three vaccine codes to focus on:

90656 (Influenza virus vaccine, split virus, preservativefree, when administered to individuals 3 years and older, for intramuscular use), 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years and older, for intramuscular use), and 90660 (Influenza virus vaccine, live, for intranasal use).

\Youll probably report 90656 more frequently than 90658. Code 90658 refers to a standard split-virus vaccination usually packaged in multi-dose vials that physicians use less frequently. Thats the only difference between the first two codes.

Remember to check the documentation or the vaccines packaging to determine which type of the first two vaccines the staff administered. The CDC provides a list of manufacturers and corresponding vaccine status:

www.cdc.gov/flu/about/qa/vaxsupply.htm#table.

Now that more physicians are using the intransasal flu vaccination, you should confirm that staff injected the patient before you report one of the above codes. If the physician performed the vaccination intranasally, you should use 90660.

As far as injection, if the flu shot is the primary vaccine that your physician orders, bill private carriers with 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/ toxoid]). If staff administers the flu shot in addition to another separately injected vaccine for a private insurance patient, you should also report +90472 (& each additionalvaccine [single or combination vaccine/toxoid] [List separately in addition to code for primary procedure]) to reflect the second immunization. If the staff administers an intranasal vaccine, you should bill private payers with 90473 (Immunization administration by intranasal or oral route; one vaccination [single or combination vaccine/ toxoid]) or +90474 (... each additional vaccine [List separately in addition to code for primary procedure]).

If you bill Medicare for the flu shot administration, report G0008 (Administration of influenza virus vaccine).

If you treat a Medicare patient with the intranasal vaccine, you should avoid 90473-90474 and stick with G0008.