Cardiology Coding Alert

The medical community is abuzz that swine flu (H1N1) could be particularly dangerous for heart patients, putting them at the top of the vaccination priority list. If your practice expects to administer the vaccine, don't miss what a recent Medicare Physician Fee Schedule (MPFS) update reveals about which codes belong on your claim.

CMS added two H1N1-related codes to the fee schedule, effective Sept. 1 (Transmittal 1810, CR 6617):

• Administration: G9141 -- Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family)

• Vaccine: G9142 -- Influenza A (H1N1) vaccine, any route of administration.

Because the H1N1 vaccine is available to providers free of charge, you should not bill Medicare for the vaccine -- only for the administration, said CMS's Stewart Streimer during an Aug. 25 CMS Open Door Forum.

What to do: You should report one unit of G9141 for each H1N1 vaccine administration. If you do report G9142 (the vaccine) CMS will deny only that line item, according to MLN Matters article SE0920 (www.cms.hhs.gov/MLNMattersArticles/downloads/SE0920.pdf).

CMS intends to pay you the same amount for G9141 as it reimburses for G0008 (Administration of influenza virus vaccine) and G0009 (Administration of pneumococcal vaccine). "The reimbursement varies by state, but ranges from about $18 to $25," says Jay Neal, a coding consultant in Atlanta. You can find your state's rate at www.cms.hhs.gov/AdultImmunizations/Downloads/AdminRates09.pdf.

Although Medicare normally pays for just one vaccination per year, it will pay for both a seasonal flu vaccine and an H1N1 vaccine if both are medically necessary, according to the MLN Matters article.

Private payer tip: For a non-Medicare patient receiving the H1N1 vaccine, you should submit the  current code for a general pandemic vaccine (90663,Influenza virus vaccine, pandemic formulation), according to the AMA (www.ama-assn.org/ama1/pub/upload/mm/362/vaccine-codes.pdf).

You would report the appropriate immunization administration code (90465-90474) together with 90663 for the vaccine administration, depending on the administration route and the patient's age. As for Medicare patients, if your cardiology practice obtains the vaccine for free, you should bill only the admin code. Keep in mind: Many commercial payers will want to know the type of vaccine, so you can report 90663 with a $0.00 or $0.01 charge.

The latest MPFS update also has an answer if you've been wondering whether you may collect for 93351-26  (Echocardiography, transthoracic, real-time with image documentation [2D], includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision; Professional component) performed in a facility -- and the answer is yes.

The update states, "Transmittal 1748 [May 29, 2009] noted that this service is typically not paid under the Medicare physician fee schedule when provided in a facility setting and the PE RVUs [practice expense relative value units] noted were informational only. We would like to clarify that CPT code 93351 (26) is payable when performed by a physician in a facility setting and the payment file has been updated to reflect this change."

Resource: You can find the fee schedule update at www.cms.hhs.gov/transmittals/downloads/R1810CP.pdf.