Correctly Code to Get Paid for Immunizations
Published on Sat Jan 01, 2000
To get reimbursed for giving a patient a vaccination, either on its own or as part of a preventive medicine services visit, you need to get paid for the vaccine itself, the administration and the visit unless the patient isnt seen by a physician. If a nurse sees the patient, you will get paid only for the vaccine and the administration.
Beyond this basic rule, however, there are numerous problems created partly by managed care, which isnt sure it wants to pay for the new administration codes (90471 for a single or combination vaccine, 90472 for each subsequent single or combination vaccine). These codes were actually instituted in 1999, but their definition was updated in 2000.
If you see a patient for a well visit and give a vaccination (or several), you would code the age-appropriate code (99381-99387 for new patients, 99391-99397 for established patients).
CPT 2000 Update
There is now a revised description which makes it possible for physicians to get paid more for administering each vaccine or combination vaccine especially when administering more than two. The vaccine administration codes issued in 1999 were found faulty immediately. Code 90471, which is for one vaccine, is fine. But 90472 is for two or more, and that, when physicians are frequently administering three, four, or even five is not fair. CPT 2000 redefined the second code to be for each subsequent vaccination. So now, practices will be able to bill for each vaccine they administer.
Medicare, however, does not recognize the 90471 or 90472 administration codes. Rather, for Medicare patients, you should use the HCPCS codes for administration. These are G0008 for flu, G0009 for pneumonia, and G0010 for hepatitis B, says Kent Moore, manager of reimbursement issues for the American Academy of Family Physicians (AAFP).
Now, lets say the patient is covered by a commercial HMO. A typical case for a family practice physician is a child coming in for immunizations which the physician decided not to give two weeks ago during the preventive medicine services visit because otitis media was discovered at the time. How should the vaccination-only visit be coded when the nurse is the only one who sees the child?
The answer, says Moore, is to use only the administration code and the vaccine product code. Do not use 99211, the nurse-visit code which most physicians were using prior to the new vaccine administration codes for 1999. Note that since the well visit is not actually being done in this example, you will not be able to use the well-visit diagnosis code; rather, you will need to use the specific vaccination code (V03.x, V04.x, V05.x, or V06.x). Some practices also use V05.8 (other [...]
