Pulmonology Coding Alert

Code needle immunizations differently from intranasal ones 'Tis the season: Patients have been heading to the office for their annual flu vaccinations, and coders should prepare by boning up on the different coding methods for these services. Choosing the right flu shot vaccination codes is a two-step process that is governed by different rules depending on the payer. Check out this plan that will make your flu shot coding a cakewalk. Answer Preservative Question, Then Choose Code Patients who require flu vaccinations from your pulmonologist will allow you to report a pair of codes for the service: one for the vaccine, and another for the administration. You'll choose one of the following vaccine codes on your flu vaccination claim, says Sheldrian LeFlore, CPC, revenue management educator with The Coding Group in Carlsbad, Calif: • 90656 -- Influenza virus vaccine, split virus, preservative-free, when administered to 3 years of age and older, for intramuscular use • 90658 -- Influenza virus vaccine, split virus, when administered to 3 years of age and older, for intramuscular use. The difference: Use 90656 if the pulmonologist administers a preservative-free vaccine; reserve 90658 for vaccines containing preservatives, LeFlore says. If your office has preservative-free vaccines, expect patients to ask for them. Patients are becoming more discerning when choosing a vaccine; as a result, more of them request the preservative-free vaccine, says Karen Deardurff, CPC, coder at Saint Joseph Physician Network in Mishawaka, Ind. When choosing the vaccine code, make sure you have the right one. "It is important not to guess" whether a vaccine has preservatives or not, because this could result in a financial loss for the practice as the preservative-free vaccine costs more than the standard one, LeFlore says. Conversely, you do not want to receive increased payment for reporting 90656 when the practice provides a standard vaccine to the patient. If you are unsure about the contents of the vaccine, the packaging it came in will help you answer the preservative question. Or you can consult the vaccine manufacturer to check if the product has preservatives. Then, be sure to "educate physicians on documenting this information in the medical record. Ultimately, the medical record is the source document" for choosing the code, LeFlore says. Tip: The lot number should contain the vaccine brand name -- such as AfluaXXXXX. This term represents Fluarix, a preservative-free product prepared in single-dose vials that have been processed to remove almost all of the thimerosal. Documentation of the brand and lot number (in addition to the pertinent clinical data, such as location given and patient's response) will justify your 90656 claim. Consult Medicare for Vaccine Admin Codes When selecting a code for the work the physician performs while [...]