Pulmonology Coding Alert

Question: What are the correct CPT® codes used to bill for a pneumovax in Medicare? I billed 90732 and 90471 with a diagnosis of v06.6. It was denied.

Colorado Subscriber

Answer: It seems from your diagnosis code that you are coding for both influenza virus and PPV vaccines together as you are reporting V06.6 (Need for prophylactic vaccination and inoculation against streptococcus pneumoniae and influenza) for their administration. In the past, you’ve linked these vaccinations to V03.82 (Need for prophylactic vaccination and inoculation against streptococcus pneumoniae [pneumococcus]) and V04.81 (Need for prophylactic vaccination and inoculation against influenza).

When reporting vaccination codes, you have to report both the actual vaccine codes and the administration codes. In Medicare, you have to separately report the administration codes for the seasonal influenza virus (G0008, Administration of influenza virus vaccine) and pneumococcal (G0009, Administration of pneumococcal vaccine) vaccines. Medicare will pay both administration fees if a beneficiary receives both the seasonal influenza virus and the pneumococcal vaccines on the same day. The administration code 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) would be erroneous for Medicare.

Billing 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use) for the vaccine will be sufficient. If you are also billing for the flu vaccine, you’ll have to bill based on the specific brand-name flu vaccine that the physician administers using the HCPCS codes that CMS has created (when applicable), such as the following:

• Q2035 -- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use; (afluria)
• Q2036 – (flulaval)
• Q2037 – (fluvirin)
• Q2038 – (fluzone)
• Q2039 – (not otherwise specified)