Internal Medicine Coding Alert

Medicare, private payer policies differ for service.

With all the swine flu hysteria, internal medicine coders need to remember how to code for standard flu vaccinations, as these are still an important part of any practice's revenue stream.

Refresh yourself with this flu coding FAQ and you'll be ready for any flu vaccination presentation -- seasonal or swine.

Choose either 90656 (Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use), 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use), or 90660 (Influenza vaccine, live, for intranasal use) for the flu shot vaccine, depending on the type of vaccine you use, confirms Jan Allen, claims and account receivable manager for three internal medicine practices in Southern California.

You'll typically report either 90656 or 90658 for your flu vaccination patients. As the descriptors indicate, one vaccine has preservatives (90658) and the other does not (90656). Allen reports a dearth of preservative-free vaccine at her practice, so she is using only 90658.

Coding depends on the route and the payer. For commercial carriers, you'd code 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections];one vaccine [single or combination vaccine/toxoid]) for a vaccine via injection; if the internist delivers the vaccine intranasally, report 90473 (Immunization administration by intranasal or oral route; one vaccine [single or combination vaccine/toxoid]) instead, says Jacqueline Stack, AAB, CPC, CPC-I, CEMC, CFPC, CIMC, CPEDC, CCP-P, of Seneca Medical Center, LLC in Oil City, Pa.

When the patient has Medicare, you'll choose G0008 (Administration of influenza virus vaccine) for the administration -- regardless of the route, reports Stack. Report the vaccine supply the same way for all payers.

Example 1: The internist performs a preservative-free intramuscular flu vaccination on a 79-year-old Medicare patient. In this case, you'd report G0008 for the administration and 90656 for the supply.

Example 2: The internist performs flu vaccination via intramuscular injection for a 46-year-old patient with commercial insurance. The vaccine contains preservatives.

On the claim, you'd report 90471 for the administration and 90658 for the vaccine.

Hot tip: Check with your commercial carriers to see if they accept G0008 for flu administration; Stack reports that a lot of them are open to G0008, and this could simplify your coding.

Again, payers' rules diverge. For commercial insurers, you'll report +90472 (... each additional vaccine [single or combination vaccine/toxoid] [List separately in addition to code for primary procedure]) or +90474 (... each additional vaccine [single or combination vaccine/toxoid] [List separately in addition to code for primary procedure]) for additional vaccine administration[s], along with the appropriate supply code[s].

Private payer example: The internist provides a preservative-free flu vaccination via intramuscular injection for a 56-year-old patient with commercial insurance. He also administers a pneumonia vaccination for the patient. On this claim, you'd report the following:

• 90471 for the flu vaccination,

• 90656 for the supply,

• +90472 for the pneumonia vaccine administration, and

• 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 pneumonia vaccine supply.

Medicare wants you to use its G code for the second administration as well, if one exists. You have access to a G code for pneumonia vaccination, so you'd code the above combination thusly for Medicare patient:

Medicare example: The internist provides a preservative-free flu vaccination via injection for a 76-year-old Medicare patient. He also administers a pneumonia vaccination for the patient. On this claim, you'd report the following:

• G0008 for the flu vaccination,

• 90656 for the supply,

• G0009 (Administration of pneumococcal vaccine) for the pneumonia vaccine administration, and

• 90732 for the supply.

Good to know: G0010 (Administration of hepatitis B vaccine) is another G code that Medicare requires you use for vaccinations.

For flu vaccinations, V04.81 (Need for prophylactic vaccination and inoculation against certain diseases; other viral diseases; influenza) is all you'll need to prove medical necessity, Stack confirms. If the patient receives multiple vaccinations, make sure to include an ICD-9 code that represents each one.