Cardiology Coding Alert

Question: Should we use a HCPCS code for basic flu vaccine supply?

Answer: Assuming you're referring to HCPCS Level II codes, the answer depends on your payer.

CPT offers 90656 (Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use) or 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use) for flu vaccine supply.

How to choose: You'll use 90656 for vaccines without preservatives, and 90658 when the vaccines contain preservatives. One way to tell if the vaccine has preservative is to check its packaging. The insert in the package indicates whether it has thimerosal preservative.

If the packaging does not help, contact the manufacturer and ask if the vaccine contains thimerosal. Then, make sure other coders and physicians know which vaccines contain preservatives and which do not. Most of the single-dose pre-filled syringes are preservative-free, whereas the multi-dose vials are not.

Medicare: CMS created five Q codes to replace 90658 for the 2010 to 2011 flu season:

• Q2035 -- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
• Q2036 -- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
• Q2037 -- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
• Q2038 -- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
• Q2039 -- Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified).

In a confusing twist, the Q codes are effective for services on or after Oct. 1, 2010, but the Medicare claims processing system won't recognize the codes until Jan. 1, 2011. Medicare instructs that you may either bill Oct. 1, 2010, to Dec. 31, 2010, services using 90658 or you may hold those claims until Jan. 1 and bill using the appropriate Q code.

Resources: MLN Matters article MM7234 explains proper use of the new Q codes: www.cms.gov/MLNMattersArticles/downloads/MM7234.pdf.

Admin: For administration to non-Medicare patients, you should report 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]).

For Medicare patients, you should instead report G0008 (Administration of influenza virus vaccine) for the flu vaccine administration.