Pulmonology Coding Alert

Don’t forget to assign Z23 for a vaccination encounter.

Knowing which influenza vaccine product code to assign for an encounter depends on the vaccine type, dose, and administration method. The flu vaccines for the 2022-2023 flu season are quadrivalent formulas, which narrows down your CPT^® code search.

Pulmonology Coding Alert breaks down the quadrivalent flu vaccine codes for this flu season and shows you how to code different scenarios.

Get to Know the 2022-2023 Flu Vaccine Codes

The flu vaccines created for the 2022-2023 flu season are quadrivalent vaccines. This means the vaccines are formulated to help protect against four different flu viruses. This flu season, the quadrivalent vaccines offer protection against two influenza A strains and two influenza B strains.

According to the Centers for Medicare & Medicaid Services (CMS), nine CPT^® codes are priced for reimbursement during the 2022-2023 flu season (www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing). The codes include:

• 90662 (Influenza virus vaccine (IIV), split virus, preser­vative free, enhanced immunogenicity via increased antigen content, for intramuscular use)
• 90672 (… quadrivalent, live (LAIV4), for intranasal use)
• 90674 (… quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use)
• 90682 (… quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use)
• 90686-90688 (… quadrivalent (IIV4) …)
• 90694 (… quadrivalent (aIIV4), inactivated, adjuvanted, preservative free, 0.5 mL dosage, for intramuscular use)
• 90756 (… derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use)

The Centers for Disease Control and Prevention (CDC) issued recommendations for this flu season for patients 65 years and older. “For 2022-2023, the preferred vaccines for this older population are Fluzone High-Dose Quadrivalent vaccine (90662), Flublok Quadrivalent recombinant flu vaccine (90682), and Fluad Quadrivalent adjuvanted flu vaccine (90694). Based on clinical studies, it has been suggested that these particular vaccine types promote a more robust immune response,” says Carol Pohlig, BSN, RN, CPC, manager of coding and education in the department of medicine at the Hospital of the University of Pennsylvania in Philadelphia.

“Given their increased risk of flu-associated severe illness, hospitalization, and death, it’s important to use these potentially more effective vaccines in people 65 years and older,” said José R. Romero, MD, director of CDC’s National Center for Immunization and Respiratory Diseases in a June 30, 2022, statement (www.cdc.gov/media/releases/2022/s0630-seniors-flu.html).

Now that you’re familiar with the flu vaccine codes, review the scenario below to understand how to correctly code a flu vaccine administration encounter.

Report Vaccine Administration During an E/M Visit

Scenario: An established patient arrives for a follow-up evaluation and management (E/M) visit for their moderate persistent asthma. During the visit, the patient states they haven’t received their flu vaccine yet. The physician offers to administer the vaccine while the patient is at the appointment, and the patient agrees. The physician administers a 0.5 mL dose of a ccIIV4 flu vaccine into the patient’s left arm.

“It is always prudent to list the CPT^® codes in order of value on a claim, highest to lowest,” Pohlig says. For additional services performed during an in-person E/M visit, you’ll report the E/M visit first, followed by the vaccine administration, and then the vaccine product.

You’ll report the E/M visit with 99213 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using time for code selection, 20-29 minutes of total time is spent on the date of the encounter.). During the same encounter, the physician administered an intramuscular 0.5 mL dose of a ccIIV4 influenza vaccine.

Beware of bundling: Since providers often administer vaccines during office visits, you’ll need to append a modifier to indicate the vaccine administration was a separate service from the E/M visit. “Remember that the E/M will bundle into the vaccine administration, so you should report modifier 25 [Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service] with the visit to demonstrate the visit was separately identifiable from the vaccine administration,” Pohlig adds.

Next, you’ll assign the correct codes to report the administration and which vaccine the provider administered. You’ll assign 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)) to report the intramuscular administration of the flu vaccine, whereas you’ll assign 90674 for the specific flu vaccine.

Mind the payer: If your provider administers a flu vaccine to a Medicare patient, then you’ll assign G0008 (Administration of influenza virus vaccine) instead of 90471, which is designated for commercial payers. Of course, you should check your individual payer preferences to know which influenza vaccine administration code to assign.

Lastly, you’ll also need two diagnosis codes to reflect the vaccine administration and the condition being managed during the E/M visit. The ICD-10-CM codes you’ll assign for this scenario are J45.40 (Moderate persistent asthma, uncomplicated) and Z23 (Encounter for immunization).