Pulmonology Coding Alert

Question: We give quite a few flu shots at our pulmonology practice, and the doctor said she heard at a conference that many of the codes have changed for 2018. Is that accurate, and if so, which new codes should we use?

Codify Subscriber

Answer: There are indeed some changes to the flu shot codes, several of which you may already have heard of. For instance, 90682 (Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use) joins 90756 (Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use) as new additions to CPT^® 2018.

Technically, however, neither code is new. Code 90682 made its appearance on the AMA web site on July 1, 2016, and became effective January 1, 2017, but 2018 marks the first year it will appear in the CPT^® book. Some payers began accepting 90756 - known by its trade name, Flucelvax - on July 1, 2017. But if your payer is not recognizing the code, you can use 90749 (Unlisted vaccine/toxoid) or HCPCS code Q2039 (Influenza virus vaccine, not otherwise specified) in its place.

You'll also be able to document 90750 (Zoster (shingles) vaccine (HZV), recombinant, sub-unit, adjuvanted, for intramuscular injection) after the first of the year if your provider administers this vaccination to help prevent an occurrence or reoccurrence of shingles in patients over the age of 60. According to CPT^®, Food and Drug Administration (FDA) approval of this vaccine is pending.

According to CMS data, you'll collect $46.313 from Medicare for 90682 and $22.793 for 90756. To accessadditional pricing for 2018 vaccines, visit https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Part-B-Drugs/McrPartBDrugAvgSalesPrice/VaccinesPricing.html.