Internal Medicine Coding Alert

Published on Tue Nov 08, 2005 PDF

Question: Our office is expecting a shipment of the Fluarix TIV influenza vaccine. When a nurse uses this product, what codes should I report?


Illinois Subscriber

Answer: Ensure flawless submission of a Fluarix shot by taking these measures:

Step 1: To assign the appropriate administration code, check the patient's insurer. For a non-Medicare patient, code injection administration as 90471-90472 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections] ...). Assign 90471 (... one vaccine [single or combination vaccine/toxoid]) when a staff member gives Fluarix as a single or initial vaccine. Alternatively, use +90472 (... each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]) when given as an additional vaccine. For a Medicare patient, you would use G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day).

Step 2: Because Fluarix is preservative-free and adult-only, report the product with 90656 (Influenza virus vaccine, split virus, preservative-free, for use in individuals 3 years and above, for intramuscular use).

Step 3: Link both the immunization administration and the product to ICD-9 code V04.81 (Need for prophylactic vaccination and inoculation against other viral diseases; influenza).

Fluarix is a trivalent preservative-free inactivated influenza vaccine (TIV) that prevents type A and B influenza. The FDA recently approved the GlaxoSmithKline intramuscular injection for adults 18 years of age and older.

Answers to You Be the Coder and Reader Questions provided by Christine DuBois, CPC, coding/compliance coordinator at Western Mass Physicians Association in Chicopee, Ma; Daniel S. Fick, MD, director of risk management and compliance at the University of Iowa in Iowa City; Kathy Pride, CPC, CCS-P, a coding consultant for QuadraMed in Port St. Lucie, Fla.; and Bruce Rappoport, MD, CPC, a board-certified internist who works with Rachlin, Cohen & Holtz LLP, a Fort Lauderdale, Fla.-based accounting firm with healthcare expertise.