Part B Insider (Multispecialty) Coding Alert

Published on Fri May 04, 2012 PDF

Inaccuracy in Medicare manual may have led you astray.

If you've been taking your Hepatitis B coding advice from the Medicare Claims Processing Manual, you could be submitting the wrong codes.

Background: In March 2011, CMS assigned code G0010 (Administration of hepatitis B vaccine) to cover hepatitis B vaccinations, and made it payable retroactive to Jan. 1, 2011. However, the Claims Processing Manual was never updated to reflect the new code, causing many practices to continue submitting the previous codes (90471-90472) for this service.

Effective April 4, 2012, CMS updated the manual to reflect the change, but if you received any erroneous denials for submitting the old codes instead of G0010 prior to that date, you can resubmit them after July 2 for adjustment, CMS notes in MLN Matters article MM7692.

Check This Primer for Hepatitis Coverage

As a reminder, Medicare will cover hepatitis B virus (HBV) vaccinations only for beneficiaries it deems "medium (or intermediate) to high risk," according to the vaccination guide.

Medium risk patients include workers in health care professions who have frequent contact with blood or blood-derived body fluids during routine work and employees at homes for the mentally handicapped.

People at high risk for the disease include persons who live in the same household as an HBV carrier, homosexuals, users of illicit injectable drugs, individuals with hemophilia (V83.xx) who received Factor VIII or IX concentrates, and people with end-stage renal disease (ESRD, 585.6) or chronic kidney disease (585.6) stage V requiring chronic dialysis.

Exception: Patients in the above-listed groups would not be considered at high or intermediate risk of contracting HBV infection if they have laboratory evidence positive for HBV antibodies.

Diagnosis: The correct V code to accompany the HBV vaccine is:

• V05.3 -- Need for prophylactic vaccination and inoculation against single diseases, viral hepatitis.

Administration: The administration code for the HBV vaccine in an office setting is:

• G0010 -- Administration of hepatitis B vaccine.

Product: Watch your step with the HBV product codes, which depend on the patient's age, medical condition, and the number of doses. Select from the following:

• 90740 -- Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use
• 90743 -- Hepatitis B vaccine, adolescent (2 dose schedule), for intramuscular use
• 90744 -- Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use
• 90746 -- Hepatitis B vaccine, adult dosage, for intramuscular use
• 90747 -- Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (4 dose schedule), for intramuscular use.

For more information on the Hepatitis B code G0010, see the new MLN Matters article at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7692.pdf.