AMA Switches Up Vaccine Coding

AMA Switches Up Vaccine Coding

CPT® 2017 introduces new codes to capture new vaccines.

The influenza virus is not a single entity, but an ever adapting “family” of viruses. To keep pace, researchers must constantly develop new vaccines, and CPT® must periodically update the codes used to report those vaccines. For 2017, CPT® introduces one vaccine code, and revises the reporting criteria for nine others.

New Code for Quadrivalent Vaccine

Code 90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use is added to improve reporting of quadrivalent vaccine (e.g., Flucelvax®). Quadrivalent vaccines contain two Influenza A strains and two Influenza B strains that the World Health Organization predicted to be prevalent during the current flu season. Note that the descriptor identifies the dosage as 0.5 mL, by intramuscular injection.

90661 Now Specifies Trivalent

Because of the addition of 90674 to describe quadrivalent vaccine ccIIV4, code 90661 is revised to indicate trivalent vaccine ccIIV3. For consistency, the code also now indicates dosage (underlined text in the descriptor is new): 90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use.

Additional Vaccines Now Reported by Dosage, Not Age

Finally, eight previously-existing influenza vaccine codes are now reported by dosage, rather than patient age (deleted text is crossed out, new text is underlined):

90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, when administered to children 6-35 months of age0.25 mL dosage, for intramuscular use

90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, when administered to individuals 3 years and older0.5 mL dosage, for intramuscular use

90657 Influenza virus vaccine, trivalent (IIV3), split virus, when administered to children 6-35 months of age0.25 mL dosage, for intramuscular use

90658 Influenza virus vaccine, trivalent (IIV3), split virus, when administered to individuals 3 years of age and older0.5 mL dosage, for intramuscular use

90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, when administered to children 6-35 months of age0.25 mL dosage, for intramuscular use

90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, when administered to individuals 3 years of age and older0.5 mL dosage, for intramuscular use

90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6-35 months of age0.25 mL dosage, for intramuscular use

90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to individuals 3 years of age and older0.5 mL dosage, for intramuscular use

Per CPT® Changes 2017: An Insider’s View, “The revision is intended to better define the influenza vaccines and further encourage reference to the products prescribing information with a licensed age indication. These revisions also need to simplify coding by avoiding expansion of coverage based on age population.”

Reporting Vaccine Administration

You may report administration of a vaccine, in addition to the vaccine itself, using the Immunization Administration for Vaccines/Toxoids codes 90460-90472.

Code 90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered describes vaccination administration for patients 18 years old or younger, when the provider counsels the patient and/or guardian on the risks, benefits, and potential side effects of the vaccination.

Note: Although a vaccine may target several strains of influenza, it is a “single” vaccine. Do not report +90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure) for administration of an influenza vaccine.

When no counseling is given for patients 18 years of age and younger, or for vaccine administration for patients over 18 years of age, turn to 90471-90474. These codes are billed per vaccination, with either 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) or 90473 Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid) for the first vaccine (depending on the method of administration).

If additional vaccines are administered at the same visit, you also may call on 90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) or +90474 Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).

Medicare Rules Are Different

For administration of a flu vaccination to Medicare patients, report HCPCS Level II code G0008 Administration of influenza virus vaccine, rather than any of the aforementioned CPT® codes. Medicare pays for a single influenza virus vaccination per influenza season (rather than every 12 months). Annual Part B deductible and coinsurance amounts do not apply. Physicians, non-physician practitioners, and suppliers who administer influenza vaccinations must be assigned on the claim for the vaccine.

 

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

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John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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