Pulmonology Coding Alert

2 tips ease your reporting for vaccine administration

Many practices miss out on 100 percent reimbursement for pneumovax vaccines, but don't let administration codes hide your full pay for these injections anymore.

Here are two tips coding experts have helped us come up with to report your pneumovax injections.

When you report 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use), this code refers only to the vaccine product, according to CPT 2004.

Tip: You should always report one of the administration codes, G0009 (Administration of pneumococcal vaccine when no physician fee schedule service on the same day) or 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections]; one vaccine [single or combination vaccine/toxoid]), to recoup your full pay, says Beverly Ramsey, CMA, CPC, CHCC, CHBC, an independent coding consultant with Doctors Management in Asheville, N.C. Code G0009 is used for Medicare patients, other coding experts advise. Most other insurers require 90471 for administration.

When you report vaccine codes 90476-90749, don't append modifier -51 (Multiple procedures), because all of these codes are modifier -51 exempt, Ramsey says. Modifier -51 is normally used when one physician performs multiple procedures (other than E/M services) at the same session, she adds.

Explanation: CPT assigns the exempt status to those vaccine procedure codes that are exempt from modifier -51 but have not been designated as an "add-on code." The main reason, Ramsey says, that the vaccine codes are modifier -51 exempt is that you typically report -51 for procedural services, but when the physician administers a vaccine, the administration doesn't require a "procedural" service.

Exception: You may append modifier -51 if the physician saw the patient on the same day. You would append -51 to the E/M code for that day, explains Karen Dorval, CPC, billing and coding specialist with the Pneumos Clinic in Bismark, N.D.

You should report diagnosis code V03.82 (Streptococcus pneumoniae [pneumococcus]) with the pneumovax vaccine, Dorval advises.

Since carriers mostly cover pneumovax for patients who are at high risk for pneumonia, Dorval says, you should also report the condition, such as 493.90 for asthma or 496 for chronic airway obstruction, that places the patient at high risk. This will signal payers to the medical necessity of the service, she says.