Primary Care Coding Alert

It's that time of year again turkey roasting in the oven, holiday gift shopping, a crispness in the air, and the sweet sound of your office mate sneezing as she copes with the flu. Patients may be coming in droves for their annual flu shots, but you may not be getting properly paid for your services.

Although four CPT codes describe the influenza vaccine (90657-90660), FPs will mainly use 90657 (Influenza virus vaccine, split virus, 6-35 months dosage, for intramuscular or jet injection use) and 90658 (Influenza virus vaccine, split virus, 3 years and above dosage, for intramuscular or jet injection use), says Sandra Soerries, CPC, CPCH, director of Healthcare compliance services with Tait Advisory Services, a consulting firm in Kansas City, Mo.

Suppliers are not providing practices with the vaccine for the whole virus this year, so coders won't be using 90659 (Influenza virus vaccine, whole virus, for intramuscular or jet injection use), and the live virus vaccine (90660) is used rarely.

Report 90657 when administering the shot to children younger than age 3 and 90658 for adults. Because the Centers for Disease Control (CDC) came out with new guidelines recommending the vaccine for children age 6-23 months, practices may be using 90657 this season more often than in past years, says A. Clinton MacKinney, MD, MS, the AAFP representative on the AMA CPT Advisory Committee and medical director at HealthPartners Central Minnesota Clinics in St. Cloud, Minn. Bill Administration Codes Always bill an administration code with the vaccine code. CPT codes 90471-90474 specifically describe vaccine administration. Do not use any other injection codes for influenza shots. Use 90471-90474 when billing for patients covered by commercial carriers. For Medicare patients, use G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day) instead of 90471-90474. Flu Shots and E/M Codes A major point of confusion when it comes to coding flu shots is whether to code an E/M visit as well. Do not use an E/M if the patient comes in just for a shot, but you can report it under certain circumstances if the patient receives the shot along with a separate procedure, Soerries says. Many coders report 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) in addition to the flu shot codes, but this is incorrect.

"When a patient gets a Depo-provera shot, for example, the nurse has to evaluate and sometimes educate that patient. You can use the nurse-visit code in addition to injection codes for those encounters," MacKinney says. [...]