Ob-Gyn Coding Alert

Pregnant women are among those at the highest risk of hospitalization and death from the H1N1 swine flu -- even the healthy ones, according to the Centers for Disease Control (CDC). That means your ob-gyn practice could see an influx of patients with swine flu or seeking swine flu vaccinations, and it's up to you to know how to report these encounters.

Provided you're up to date with the latest ICD-9 coding expert recommendations, your coding for confirmed cases should be on track. ICD-9 has fast-tracked a new code for swine flu, 488.1 (Influenza due to identified novel H1N1 influenza virus).

Reason: The number of cases is mounting, and the old code 488 was only specific for avian flu, says Melanie Witt, RN, COBGC, MA, an ob-gyn coding expert based in Guadalupita, N.M.

Don't miss: Two inclusions entries confirm swine flu's migration from 487.x (Influenza) -- the code initially identified by NCHS as the closest code to report swine flu prior to October 1 " to 488.1. According to ICD-9-CM's Tabular Addenda (www.cdc.gov/nchs/data/icd9/icdtab10add.pdf), 488.1's descriptor will include:

• 2009 H1N1 [swine] influenza virus

• novel 2009 influenza H1N1

• novel H1N1 influenza

• novel influenza A/H1N1

• swine flu.

If you're dealing with a Medicare patient, you should know CMS released information about a new H1N1 vaccine administration code. The MLN Matters article MM6617 introduces two new codes that apply to the H1N1 vaccine, as follows:

• For the vaccine, you'll use G9142 (Influenza A [H1N1] vaccine, any route of administration)

• The code for the vaccine administration is G9141 (Influenza A [H1N1] immunization administration [includes the physician counseling the patient/family]).

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

"Providers should report one unit of HCPCS code G9141 for each administration of the H1N1 vaccine," the MLN Matters article notes.

Payment: CMS intends to pay you the same amount for G9141as it reimburses for other vaccine administration codes G0008 (Administration of influenza virus vaccine) and G0009 (Administration of pneumococcal vaccine).

"The reimbursement varies by state, but ranges from about $18.00 to $25.00," says Jay Neal, a coding consultant in Atlanta. You can find your state's rate at www.cms.hhs.gov/AdultImmunizations/Downloads/AdminRates09.pdf, Neal says.

Bonus: 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 a Sept. 2 email from CMS to all fee-for-service providers.

To read the MLN Matters article regarding the H1N1 vaccination, visit www.cms.hhs.gov/MLNMattersArticles/downloads/MM6617.pdf.

You should submit the current code for a general pandemic vaccine code 90663 (Influenza virus vaccine,pandemic formulation) for a non-Medicare patient receiving the H1N1 vaccine, according to the AMA. You would report the appropriate immunization administration code (90465-90474) in conjunction with 90663 for the administration of the vaccine, depending on the route of administration and the age of the patient.Obviously, if the ob-gyn practice obtains the vaccine for free, you should bill only the administration code. Keep in mind: Most commercial payers will want to know the type of vaccine, so you can report 90663 with a $0.00 or $0.01 charge.