Pulmonology Coding Alert

CMS changed the rules for flu-shot diagnoses -- get the details below

Flu season is under way, so you probably have patients lined up at your door for their shots. Ease your flu-shot coding worries with five quick tips that can put you on the fast track to reimbursement.


Tip 1: Select the Code for the Vaccines

Reporting a flu shot is a two-code process, and you should first choose the correct vaccine code, and then the appropriate administration code.

To determine which vaccine code applies to your patient, you should direct your attention to codes 90656 (Influenza virus vaccine, split virus, preservative-free, when administered to 3 years of age and older, for intramuscular use) and 90658 (Influenza virus vaccine, split virus, when administered to 3 years of age and older, for intramuscular use).

What's the difference? You'll probably report 90658 more frequently than 90656, because 90656 refers to a preservative-free vaccination, which physicians use less frequently. That's the only difference between the two codes.

You should check the documentation or the vaccine's packaging to determine which type the staff administered, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CPC-P, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

Double-check the administration method: Because more and more physicians use intransasal flu vaccinations each year, you should confirm that staff injected the patient before you report one of the above codes. If the physician performed the vaccination intranasally, on or after Oct. 1, 2006, you should instead report 90660 (Influenza virus vaccine, live, for intranasal use).

Tip 2: Pin Down the Administration Code

Now that you've got your vaccine code in check, you should select the correct code to reflect the practice staff's work administering the shot.

If the flu shot is the primary vaccine that your physician orders, bill private carriers with 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]).

If staff administers the flu shot in addition to another separately injected vaccine for a private insurance patient, you should also report +90472 (... each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]) to reflect the second immunization.

Medicare wants G codes: If you bill Medicare for the flu shot administration, report G0008 (Administration of influenza virus vaccine). If the pulmonologist's staff administers an intranasal vaccine, you should bill private payers with 90473 (Immunization administration by intranasal or oral route; one vaccination [single or combination vaccine/toxoid]) or +90474 (... each additional vaccine). If you treat a Medicare patient with the intranasal vaccine, you should avoid 90473-90474 and instead stick with G0008.


Tip 3: Know Your Diagnosis Code

Medicare and most private insurers instruct physicians to link the flu vaccine codes [...]