Internal Medicine Coding Alert

Published on Mon Feb 02, 2009 PDF

Question: We have several average-risk Medicare patients scheduled to come in for pneumonia vaccinations this week. Will Medicare cover the encounters?

Oregon Subscriber

Answer: As long as the patients have never had a Medicare-covered pneumonia vaccination before, the carrier will pay for the encounter. Medicare allows for one pneumonia vaccination per average-risk patient per lifetime, according to Noridian's policy on pneumococcal vaccinations. For average-risk patients having their first (and only) Medicare-covered pneumonia vaccination, report the following:

• 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use) for the vaccine supply

• G0009 (Administration of pneumococcal vaccine) for the vaccine administration

• V03.82 (Other specified vaccinations against single bacterial diseases; streptococcus pneumoniae [pneumococcus]) appended to 90732 and G0009 to indicate the patient's vaccine type.

Best bet: Check out the CMS reference guide for preventive services at: http://www.cms.hhs.gov/MLNProducts/downloads/MPS_QuickReferenceChart_1.pdf.

-- Answers to You Be the Coder and Reader Questions were reviewed by Bruce Rappoport, MD, CPC, CHCC, a board-certified internist and medical director of Broward Health's Best Choice Plus and Total Claims Administration in Fort Lauderdale, Fla.