Urology Coding Alert

Even if you only have to report one immunization this year, make sure you won’t forfeit reimbursement.

While general health immunizations may not be commonplace in your practice, many specialists, including urologists, offer the flu shot for patients in their office to keep patients healthy. If you don’t know how to report those injections, your practice will face denials as this flu season drags on. 

You’ll need to look for these key terms in the chart documentation when coding for influenza vaccines: Age, Active/Inactivated, Recombinant or Live Attenuated; preservative (thimerosol, Hg) free, high-dose, administration route, and tri- or quadrivalent. There are new 2015 CPT® codes, including 90630 for quadrivalent, split virus, preservative free, intradermal injection.  Don’t forget to capture vaccine administration CPT® codes 90471-90474, in addition to the vaccine codes listed in the table below, says Betty Anne Price, BSN, RN, President and CEO of PRCS, Inc. in Palmetto, Fla.

Good news: Medicare continues to cover many seasonal influenza vaccines without coinsurance or co-payment deductions. CMS rescinded Transmittal 3029, replacing it with Transmittal 3033 on Sept. 3, 2014.Medicare payment rates for seasonal vaccines are effective Aug. 1, 2014 through July 31, 2015. 

Heads up: Stay alert when using CPT® codes 90654, 90662, 90672, and 90673.Medicare local claims contractors will determine whether the charges are reasonable and necessary for payment. Similarly, payment for HCPCS Q2039 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) is a local contractor discretion, Price warns.

Keep this chart from Price handy to help when you’re billing flu shots this season. Take the guesswork out of matching upbrand name vaccines to the corresponding CPT® code for 2015.

Table Adapted from http://www.cdc.gov/flu/protect/vaccine/vaccines.htm