Primary Care Coding Alert

Question: Our office is expecting a shipment of the Fluarix TIV influenza vaccine. When a nurse uses this product, what codes should I use?


Illinois Subscriber


Answer: There are three quick steps to coding this service:

Step 1: Check the patient's insurer to determine how you should report the immunization administration. For a non-Medicare patient, assign 90471-90472 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections] -).
 
Assign 90471 (- one vaccine [single or combination vaccine/toxoid]) when staff give Fluarix as a single or initial vaccine, or +90472 (- each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]) when given as an additional vaccine.

If the patient is on Medicare, use G0008 (Administration of influenza virus vaccine when no physician fee schedule service on the same day).

Step 2: Because Fluarix is preservative-free and adult-only, report the product with 90656 (Influenza virus vaccine, split virus, preservative-free, for use in individuals 3 years of age and above, for intra-muscular use).

Step 3: Link both the immunization administration and the product to ICD-9 code V04.81 (Need for prophylactic vaccination and inoculation against other viral diseases; influenza).

Fluarix is a trivalent preservative-free inactivated influenza vaccine (TIV) that prevents type A and B influenza. The FDA recently approved the Glaxo-SmithKline intramuscular injection for adults 18 years of age and older.