Avoid Pitfalls of New Vaccine Codes with Updated Superbills and Reimbursement Strategies
Published on Mon Mar 01, 1999
In CPT 1999, there are 24 new codes and 30 revised codes for vaccines. In addition, there are two new codes for their administration. These changes reflect the development of several new vaccines, as well as new product-specific codes given to existing vaccines. There are also multiple codes for some drugs when administration schedules differ based on age or dose. And, while we hear that many insurance companies are slow to get the new and revised codes on their systems, most will finally be updated by April (the date that Medicare has set for implementation of the new codes).
This means pediatric superbills need to be changed, according to the American Academy of Pediatrics RBRVS Project Advisory Committee (RBRVS PAC). As the RBRVS PAC states in its winter coding and reimbursement update: If pediatricians had not planned to revise their encounter forms this year, they should think again!
Changing the Superbill
How are practices coping with the changes? Tina Cressman, CPC, reimbursement analyst for the 45-pediatrician Cooper Health System in Camden, NJ, is doing a two-phase change of her superbill this year. We put in the other new codes in January, but for the vaccines, were waiting until April 1, says Cressman. Thats because we found a lot of insurance companies wont be accepting the new vaccine codes until then. Cressman will hold off on putting the new vaccine administration codes (90471 and 90472) on the superbill until April, as well.
And she stresses that it is very important for the precise vaccine code to be on the superbill. The pediatrician should be the one indicating the service, says the coder. This cant be left up to translating from notes or cheat sheetsthat just makes an extra step where an error can be made.
Lynn Bloom, insurance administrator for Maple Avenue Pediatrics, a four-pediatrician practice in Fair Lawn, NJ, agrees that there are problems with the new vaccine codes. I am seeing recognition for the new rotavirus vaccine code (90680), but not for the administration codes, she reports. "My EOBs all say invalid CPT Codes . Bloom has decided not to file the new administration codes until she has some indication that the managed care companies she works with will recognize them.
This is one optionwe can understand why someone wouldn't want to re-file all those claimsbut that doesnt mean you cant be ready with the updated encounter form.
But not all practices want to add the new vaccine product codesat least not on the pediatricians encounter form. Barbara Brenton, office manager for North Park Pediatrics, a four-pediatrician, [...]
