Pulmonology Coding Alert

Question: Our practice has been receiving queries for H1N1 vaccinations. What are our coding options and restrictions?

New Jersey Subscriber

Answer: You should now code H1N1 vaccination as you would any other influenza vaccines. According to CDC the H1N1 virus that caused that pandemic is now a regular human flu virus and continues to circulate seasonally worldwide. 

You will report most types of flu injections, including a vaccine like the H1N1 shot, using two codes:

• A code for the flu vaccine itself, depending upon the type of vaccine (injectable liquid, intranasal mist, intraoral), whether it’s preservative-free and whether the receiver is a Medicare beneficiary.

             o  Use from within 90654-90688 codes for the particular vaccine you may using. Use from within Q2033-Q2039 for Medicare beneficiaries, when applicable

• A code for the administration of the injection 

             o  Use 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) for single injection
             o  Use 90472 (…each additional vaccine [single or combination vaccine/toxoid]) for subsequent injections
             o  Use 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]) for single intranasal or intraoral application
             o  Use 90474 (…each additional vaccine [single or combination vaccine/toxoid]) for additional intranasal or intraoral applications

• You will use administration code G0008 for Medicare-only patients (and those that follow Medicare guidelines)

Tip: Make sure you report V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; other viral diseases; influenza) as your diagnosis. Medicare has fixed the payment at same rates as the administration of the seasonal influenza vaccine (G0008, Administration of influenza virus vaccine).