Primary Care Coding Alert

Question: We are having difficulty getting paid by Medicare in two areas. First, Medicare has not been paying for blood draws done in our office. We have been coding these G0001. Second, Medicare would not reimburse us for the flu shots we gave to our patients last fall. We assigned an administrative fee for the flu shots, as well as 90659 for the actual vaccine. What do you suggest we do differently to increase reimbursement?

Sandy Nelson
Harbor Family Health, Aberdeen, Wash.

Answer: You should receive payment when you code blood draws with HCPCS code G0001 (routine venipuncture for collection of specimen[s]). But you also need to assign a diagnosis for the blood draw that clearly describes the reason for the lab work performed that day. For instance, you may want to check levels on a thyroid patient and so would assign ICD-9 code 244.9 (unspecified hypothyroidism).

You would code the administration of the flu shot with HCPCS code G0008 (administration of influenza virus vaccine when no physician fee schedule service on the same day). In addition, you must be sure to add the appropriate diagnosis code that justifies the vaccination: ICD-9 code V04.8 (need for prophylactic vaccination and inoculation against certain viral diseases; influenza). This diagnosis code also should be assigned with CPT code 90659 (influenza virus vaccine, whole virus, for intramuscular or jet injection use).