Precision is Key With Flu Vaccine Claims

Accurate payment for seasonal influenza (flu) virus vaccines requires precise coding. And to accomplish that, coders have to pay attention to details.

“Make sure you code correct route, correct product, correct ICD-9,” says Cathy Gray, RHIT, CCS, CPC-I, CCC, CGIC, with Henry Ford Health System in Detroit, in a recent issue of Pediatric Coding Alert.

Ask yourself the following questions:

1. Is the flu product the patient receiving preservative-free?

Preservative-free products cost more and, as such, reimburse at a higher rate. Report the wrong product code and your office loses money.

2. How old is the patient?

You should also base your product code selection on the patient’s age. Vaccines administered to individuals 3 years of age and older pay more than those given to children 6-35 months.

3. What came first, the shot or the spray?

The order in which you code services can affect how much your practice is reimbursed. If a patient receives an intranasal flu vaccine at the same time as an injectable vaccine, for example, code the injectable first.

4. Which vaccine administration code set should I use?

You should use the administration code set that best represents the patient’s age and physician (or other health care professional) counseling, advises Pediatric Coding Alert. Consult your payer to confirm whether it pays more for 90465 – +90468 than for the comparable 90471 – +90474 code set.

Read the complete Pediatric Coding Alert article, entitled “4 Coding & Billing Steps Boost Your Flu Prevention Pay by $38.”


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