Wiki Billing a 90471 vs G0008 for commercial ins

[BrandiRoe]

Our clinic (which is non affiliated with the hospital) uses the same EMR as our local hospital. They have it set up so that G0008 is billed for flu immunizations no matter what insurance they have. I questioned if we could set our clinic up to not default to this (there is a $12 less reimbursement rate for G0008 vs 90471). I was told this is why they have it set up that way:

"Per CPT, code/bill the service that accurately identifies the service performed. Do not select a code that merely approximates the service provided. Per HCPCS, when both a CPT and HCPCS code have virtually identical narratives for a service, the CPT code should be used. If the narratives are not identical (e.g. the cpt code narrative is generic, whereas the HCPCS code is specific), the HCPCS code should be used.

G0008 = Admin of Influenza Vaccine
G0009 = Admin of Pneumococcal Vaccine
90471 = Immunization Admin of 1 vaccine
90472 = Immunization Admin of 2 or more vaccines"

So now me and my billing manager are questioning whether we have been billing incorrectly for commercial payers. I would love some feedback from other professionals.
Thanks
Brandi

 

[stacidawn]

We are a FQHC/Family Practice office and we bill the 90471 and 90472 to Medicaid and commercial payers. We bill the G0008 and G0009 to Medicare and Medicare replacement plans (Humana Medicare) only. I hope this helps.