Part B Insider (Multispecialty) Coding Alert

Published on Tue Jul 28, 2009 PDF

Plus: CMS officials reiterate how you can update your provider enrollment documentation.

There will soon be a new vaccine in your inoculation arsenal, but you don't yet have a code to report it. Never fear, CMS says -- a new code is on the way that you can use to bill administration of the H1N1 vaccine.

A vaccine to guard against H1N1 -- also known as the "swine flu" -- is expected to be available in mid-October, noted CMS's Stewart Streimer during an Aug. 25 Physicians Open Door Forum (ODF).

"Very shortly, we'll be publishing some change requests that talk to how one will bill for the H1N1 vaccine," Streimer indicated.

"The vaccine itself will be made available to the provider community free of charge," Streimer said. Therefore, you won't bill Medicare for the vaccine itself -- only the administration. CMS will announce the newly-created administration code in an upcoming special edition MLN Matters article. "The payment for the administration will be the same as for the seasonal flu administration," Streimer indicated.

Plus: Also on the ODF call, Patricia Peyton from CMS's provider supplier enrollment office reminded practitioners that there are certain instances when you must update your Medicare enrollment forms, either on paper or using the internet-based PECOS system.

"We do have some documents on the Medicare provider supplier enrollment web page that tell you exactly what needs to be updated and when," Peyton said. For instance, group practices have to report changes in ownership, practice locations, or final adverse actions within 30 days of the change. They should report changes in a legal business name or banking arrangements within 90 days.

Keep in mind: If you enrolled in Medicare before 2003 and you have not submitted any updates since then, you should revalidate your enrollment information by submitting the full enrollment application to your MAC or by using internet-based PECOS.

Plus: If your physician acquired his NPI from a university or academic medical institution but then left that institution and made a change in practice -- for instance, changed specialties or his last name -- the institution cannot make updates in the NPPES system for you. The physician must update his own information, Peyton said.