Part B Insider (Multispecialty) Coding Alert

Published on Thu Jul 04, 2013 PDF

A Maryland practitioner is in the hot seat for providing — and billing Medicare for — repeat pneumococcal vaccinations. And if you’re not careful, you could be next.

Background: “Current vaccination recommendations state that individuals without immunocompromising medical conditions should receive a single pneumococcal vaccination at the age of 65 years or older and that individuals with immunocompromising conditions should receive a second vaccination 5 years after their first,” the OIG says in a new report, “Potentially Improper Frequency of Pneumococcal Vaccinations for Medicare Beneficiaries” (OEI-07-13-00310). “Medicare instructs providers to administer a pneumococcal vaccination if a beneficiary is uncertain of his or her vaccination history in the past 5 years.”

In a study of beneficiaries served from 2007 to 2011, an unnamed Columbia, Md., provider ranked number one on the list of providers furnishing repeat vaccinations under HCPCS code 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use), the OIG says. The HHA administered repeat vaccinations to 754 beneficiaries via locations with multiple NPIs.

Overall, 43 percent of providers gave patients the repeat vaccinations. The remaining patientsreceived vaccinations from different providers.Medicare spent nearly $7 million on the repeat shots, the OIG says.

Many of the unnecessary vaccinations “could be reduced through providers’ reviewing the medical history of established patients,” the OIG urges. “Tools, such as electronic medical records, may assist in this effort,” the agency says in the report at http://go.usa.gov/bssj.