Coding: Influenza Vaccine Coding Hints

It's fall, and along with pumpkin patches, falling leaves, and homecoming parades, the flu clinics are in full swing.  AAFP news has some hints on coding this annual affair.

Highlights include:

• No separate code for the H1N1 vaccine this year because it is included in the 2010-2011 seasonal influenza vaccine.
• Two codes for influenza vaccination: CPT code for flu vaccine given and CPT code for vaccine administration.
• CDC's Advisory Committee on Immunization Practices has recommended that influenza vaccinations be given to all people ages 6 months and older in whom the vaccine is not contraindicated.
• Use CPT code 90662 when billing for Fluzone High-Dose, a new flu vaccine approved in December 2009 for use in people ages 65 and older.
• Medicare beneficiaries could receive a seasonal influenza vaccination twice in one calendar year for two different flu seasons; physicians can bill -- and will be paid -- for both vaccine services.

The components of this years seasonal influenze vaccine should protect against the following viruses:

•  A/California/7/09 (H1N1)-like virus (pandemic H1N1 2009 influenza virus),
• A/Perth /16/2009 (H3N2)-like virus, and
• B/Brisbane/60/2008-like virus.

Below are coding hints for this years influenza vaccination:

• G0008, Administration of influenza virus vaccine
• 90465 Immunization administration, < 8 YO (percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family: first injection (single or combination vaccine/toxoid), per day
• 90466 Each additional injection (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure)
• 90467 Immunization administration, < 8 YO (intranasal or oral routes of administration) when the physician counsels the patient/family: first administration (single or combination vaccine/toxoid), per day
• 90468 Each additional administration (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure)
• 90471 Immunization administration (percutaneous, intradermal, subcutaneous, or intramuscular injections): 1 vaccine (single or combination vaccine/toxoid)
• 90472 Each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
• 90473 Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
• 90474 Each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

For seasonal vaccine products, report the following codes:

• 90655 Influenza virus vaccine, split virus, preservative free, children 6-35 months of age, for intramuscular use
• 90656 Influenza virus vaccine, split virus, preservative free, 3 years and older, for intramuscular use
• 90657 Influenza virus vaccine, split virus, children 6-35 months of age, for intramuscular use
• 90658 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use
• 90660 Influenza virus vaccine, live, for intranasal use
• 90662 High dose influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use.

Diagnosis codes include the following:

• V04.81 Need for prophylactic vaccination and inoculation against viral diseases; influenza
• V06.6 Need for prophylactic vaccination and inoculation against combinations of diseases; Streptococcus pneumoniae (pneumococcus) and influenza.