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Influenza/H1N1

  1. #1
    Default Influenza/H1N1
    Medical Coding Books
    Has anyone researched and received information on how to code these injections this year through the major payors? (Medicare, BCBS, Medica?)

    Thanks

  2. #2
    Location
    Alexandria Minnesota Chapter
    Posts
    50
    Default
    I just read that CPT 90470 - H1N1 Immunization Administration (Intramuscular, Intranasal) and CPT 90663 - Influenza virus vaccine, pandemic formulation are available for use now.

    For Medicare, use G9141 - Influenza A (H1N1) immunization administration.
    *Do not bill: G9142 - Influenza A (H1N1) vaccine, any route of administration
    because the H1N1 vaccine will be supplied at no cost to providers.

    Dx will be V04.81 (same as regular influenza).

  3. #3
    Default H1n1
    http://news.aapc.com/index.php/2009/...-for-everyone/
    Coding for the H1N1 Vaccine

    Clinicians should use revised CPT® code 90663 Influenza virus vaccine, pandemic formulation, H1N1 to report the H1N1 vaccine product, and newly created code 90470 H1N1 immunization administration (intramuscular, intranasal), including counseling when performed to report H1N1 immunization administration and counseling.
    For Medicare, report G9142 Influenza A (H1N1) vaccine, any route of administration to describe the H1N1 vaccine itself and one unit of G9141 Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) to describe each administration of the H1N1 vaccine. Beneficiary copayment and deductible do not apply to HCPCS code G9141.
    Note that physicians cannot be reimbursed for the vaccine because it is free. Reporting G9142 is optional and edits are set up to deny the line item should it appear on a claim.
    Under the Medicare Physician Fee Schedule (MPFS), HCPCS Level II codes G9141 and G9142 are assigned status indicator “X,” indicating these codes represent an item or service that is not within the statutory definition of “physicians' services” for MPFS payment purposes.
    Heather Winters, CPC, CFPC

  4. Default H1N1 intranasal vaccine
    i have found all the info in regards to 90663 and 90470 for H1N1, but still have a question in regards to the use for 90663. I do see that it is for a (influenza virus vaccine,pandemic formulation) but does this refer to either intramuscular injection and intranasal?

  5. #5
    Default
    According to the litrature I have received from a private payor there is no distinction. You code it the same for either route of administration.
    Barbara Haskins CPC

  6. #6
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    We received this info from Cigna:

    CIGNA will reimburse health care professionals and facilities for the administration of the H1N1 vaccine to all individuals covered under a fully-insured CIGNA medical benefit plan. CIGNA is strongly recommending all self-funded plans administered by CIGNA – where the employer makes coverage policy decisions – to also provide coverage for the administration of the vaccine.

    CIGNA coverage for H1N1 vaccine administration will not be subject to plan deductibles, co-payment or coinsurance. Certain self-insured benefit plans administered by CIGNA may not adhere to this coverage policy.

    The U.S. government is making the vaccine available at no cost to you; therefore CIGNA will only provide coverage for the administration of the vaccine, in accordance with the current recommendations of the Center for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP).

    CIGNA has developed the following billing guidelines for the prophylactic administration of the H1N1 vaccine. Facilities should use Rev. Code 771 with G9141 when submitting claims for the H1N1 vaccine administration.

    H1N1 Only
    When the H1N1 vaccine is administered without the seasonal influenza vaccine, the following coding and billing guidelines should be followed:

    1) Bill G9141 -Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) for the administration of the H1N1 vaccine.

    Use G9141 to promote prompt payment as this code will not be subject to the usual copay or deductible and coinsurance.
    2) Bill V04.81 - need for prophylactic vaccination and inoculation, influenza, as the appropriate ICD-9 code.

    H1N1 and Seasonal Flu Vaccine
    When both the seasonal influenza vaccine and the H1N1 vaccine are administered to the same individual on the same date of service, follow these coding guidelines:

    1) Include G9141 and V04.81 as indicated above for the H1N1 vaccine administration; and

    2) Bill one of the appropriate seasonal flu vaccine codes:

    90655-Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use;
    90656-Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use;
    90657-Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use;
    90658-Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use; or
    90660-Influenza virus vaccine, live, for intranasal use.
    3) In addition, bill one of the following administration codes for the administration of the seasonal influenza vaccine:

    90466- Immunization administration younger than 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; each additional injection (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure);
    90468-Immunization administration younger than age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family; each additional administration (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure;
    90472-Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure); or
    90474-Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).
    No reimbursement will be made for CPT code 90663 or HCPCS code G9142, which both represent the H1N1 vaccine product.

    Roster Billers
    Health care professionals who bill as mass immunizer roster billers may submit claims for the administration of the H1N1 vaccine using the roster billing format. The above-mentioned billing guidelines must be followed and the roster must contain, at a minimum, the following information:

    Patient's name and address;
    Patient's date of birth, sex and CIGNA identification number;
    Date of service;
    Provider name and Tax Identification Number; and
    Patient or guardian signature.
    Additional Information
    Follow the current recommendations of the CDC ACIP for H1N1 vaccine administration.

    CIGNA also provides coverage for antiviral therapy (Tamiflu® (oseltamir) and Relenza® (zanamivir)) for individuals covered under a CIGNA Prescription Drug Plan, according to CDC guidelines. As a reminder, CIGNA has no precertification requirement for these antiviral drugs, but quantity limits and tiered copayments/coinsurance may apply.

    Refer to the CDC and Prevention website for the most current information on the H1N1 virus:

    CDC Swine Flu home page: http://www.cdc.gov/h1n1flu/
    CDC Clinical & Public Health Guidance: http://www.cdc.gov/h1n1flu/guidance/
    In addition, helpful information for your patients, including “H1N1 Virus: What You Should Know,” is available on www.cigna.com.
    Lisa Bledsoe, CPC, CPMA

  7. #7
    Default
    Lisa I received this also but I just want to verify that you read it the same way. The H1N1 vaccine either nasal or shot is admin code 90470 with dx v04.81? Also if we give the H1N1 and the seasonal flu shot at the same time we just use dx code v04.81, there is not a different dx code when billing them together? Thanks so much for your help! Karen

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