Ob-Gyn Coding Alert

Don't fall into this H1N1 vaccine and administration code trap.

With flu season getting underway, it's time to brush up on coding for patients who visit your ob-gyn office for vaccines. The following chart will put the right flu codes at your fingertips:

Now that you've seen what you should report for this year's flu codes, you should avoid making mistakes by checking out the following expert advice.

Strike These H1N1 Codes Off Your Vaccine Options

You may remember last year's craze to be vaccinated against H1N1 in addition to the flu, but this year's seasonal vaccine contains the H1N1 formulation.

This means you will not report the H1N1 vaccine separately with 90663 (Influenza virus vaccine, pandemic formulation, H1N1) or G9142 (Influenza A [H1N1] vaccine, any route of administration).

Nor should you bill separately for the administration of the H1N1 vaccine since it is now included in the seasonal shot (90470, H1N1 immunization administration (intramuscular, intranasal), or G9141 (Influenza A [H1N1] immunization administration [includes the physician counseling the patient/ family)]).

Summary: For this year's vaccines, do not report 90663, G9142, 90470, and G9141.

Tread Carefully With 2011's New Codes

You may have already discovered this year's four new flu vaccine codes, but you should consider these codes as those that you will use for a future pandemic strain not yet known.

These codes are:

• 90664 -- Influenza virus vaccine, pandemic formulation, live, for intranasal use
• 90666 -- Influenza virus vaccine, pandemic formulation, split virus, preservative free, for intramuscular use
• 90667 -- Influenza virus vaccine, pandemic formulation, split virus, adjuvanted, for intramuscular use››
• 90668 -- Influenza virus vaccine, pandemic formulation, split virus, for intramuscular use

"'Pandemic' means it's formulated against a strain causing epidemics worldwide," explains Nancy Bishof, MD, a physician in Lexington, Ky.

Define These Vaccine Code Key Terms

All flu vaccine options aren't created equal -- some are split virus, others are live virus. Some are preservative free, others are not. Understanding these distinctions will help you code more accurately.

A split virus vaccine consists of a purified antigenic determinant separated from the disease-causing organism. "I describe split vaccines as 'predigested' or 'broken down into little pieces' so the immune system can handle them easier or better," says Bishof.

A live virus vaccine contains an attenuated virus, meaning the virus has been altered, so it produces natural immunity but does not produce the disease. Code 90660 (Influenza virus vaccine, live, for intranasal use) represents live flu virus vaccine.

Preservative free is self-explanatory. Some vaccines include such a small, trace amount of preservatives that they meet the FDA's guidelines for "preservative free." These include 90656 (Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, forintramuscular use).

Heads up: The preservative-free vaccine takes longer to produce, which means it's available later in the fall and is more expensive.

Take Patient's Age Into Account

As noted in the descriptors above, many influenza vaccine codes specify the patient's age. Just because the code doesn't specify an age limit, however, doesn't mean one might not apply.

Example: Report 90662 (Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use) typically for patients age 65 and older. The higher antigen content offers increased protection to older patients. The vaccine may also be appropriate for people with impaired immune responsiveness, who may benefit from an increased antigen dose to more effectively stimulate the needed immune response. This formulation of the influenza vaccine contains four times the hemagglutinin antigen per influenza strain than traditional influenza vaccines.

Does Your Reimbursement Match?

A MLN Matters article (MM7120, October 22, 2010) provided a rundown of the Part B payment allowance for flu immunizations during the 2010-2011 influenza season, effective September 1, 2010. Check your fee schedules and EOBs to ensure your payments are on track:

• 90656 -- $12.375
• 90658 -- $11.368 (for dates of service September 1, 2010 through December 31, 2010)
• 90660 -- $22.316
• 90662 -- $29.213.

Annual Part B deductible and coinsurance amounts do not apply to these charges, the article notes.

Remember: Payers vary on whether they cover some of these vaccines, and the amounts they reimburse. Check your local payer contracts and guidelines for the most accurate information.