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New Flu vaccine codes for 2010

  1. #11
    Default Does New Vaccine have New Codes
    Medical Coding Books
    I was told by the vendor that H1N1 is inclusive of the seasonal flu shot, so what code should we use? I'm thinking 90655-90660.

  2. #12
    Location
    Columbia, MO
    Posts
    12,531
    Default
    It is not inclusive it has its own 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.
    The G codes are for Medicare and any other payer that wants as they are carrier discretion.
    Also from CMS:
    Neither of these revisions are in the 2010 CPT manual but were
    active codes as of September 28, 2009.
    Note: 90470 is a code which was deleted in 1999. It was revitalized
    and is now a new and different code. Some of the reimbursement
    issues may be due to its deleted status.
    To report the administration of 2009 H1N1 influenza type A
    monovalent vaccine, providers should report CPT code 90663
    (Influenza virus vaccine, pandemic formulation, H1N1) in
    conjunction with the immunization administration code 90470 (H1N1
    immunization administration (intramuscular, intranasal), including
    counseling when performed). Providers will be paid for 2009 H1N1
    vaccine administration. Since the 2009 H1N1 vaccine will be
    provided free of charge, no payment will be issued for 90663.
    CMS guidance for reporting the charge of the 2009 H1N1 vaccine
    product on the claim form is that zero dollars should be listed
    following code 90663. Other payer plans may vary. For payer
    requirements, see the payer-specific web sites for further billing
    information.
    In the event that a seasonal flu vaccination is administered in addition
    to the H1N1 vaccination at the same visit, it is necessary that code
    90470 should be reported for the initial administration service for the
    H1N1 vaccine product, and either code 90466, 90468, 90472, or
    90474 for the additional administration service. The H1N1 vaccine
    administration code should not be reported in addition to the initial
    service vaccine administration codes 90465, 90467, 90471, and
    90473 because these changes were made after the publication of the
    2010 CPT manual and therefore the add on vaccine administration
    codes have not been updated to include 90470. To reiterate, these
    changes were made after the publication of the 2010 CPT manual.
    Therefore, the instructional notes following the add-on vaccine
    administration codes have not been updated to include 90470 in the
    list of primary procedures. However, appropriate reporting of
    multiple vaccine administrations is to report one initial administration
    code and the appropriate add-on administration code(s) 90466,
    90468, 90472, or 90474 for the additional administration(s). Be sure
    to check with your payer or visit the AMA H1N1 Web site for a
    listing of payer billing requirements

    Debra A. Mitchell, MSPH, CPC-H

  3. #13
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    The original question was whether or not this year's seasonal influenza vaccine will protect against H1N1, and if so were the codes changing. I do have an e-mail from CMS entitled "August is National Immunizatio Awareness Month" which states: Seasonal Influenza Immunization

    Medicare provides payment for the seasonal influenza vaccine and its administration for all people with Medicare, once per influenza season, in the fall or winter. Medicare may cover additional influenza vaccinations, if medically necessary. (Note: According to the Centers for Disease Control and Prevention, the 2010 – 2011 influenza vaccine will protect against the 2009 H1N1, and two other influenza viruses http://www.cdc.gov/flu/about/disease/.)

    They go on to say that their Adult Immunizations Web Page (http://www.cms.gov/AdultImmunizations/) has more information, and that the Q & A Guide will be updated and posted to the site sometime in October 2010.

    That said, if the seasonal influenza vaccine we receive this year includes the H1N1, there will be no reason to code it separately, as we won't be giving separate immunizations. Also, according to practice at our organization, last year we did not give the seasonal and H1N1 on the same date. (Of course, part of that may have been availability and who was and wasn't eligible to get the H1N1 when we were still short of it!)
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  4. #14
    Default
    I am a little confused please correct me. I read that code 90656 should be used for the influenza immunization this year 2010 because H1N1 was included in the vaccine. Is this correct...I have been currently using 90658...Please advise. Thanks!
    Cynthia_,CPC,CPC-P,CPMA,RMC[/SIZE]

  5. #15
    Location
    Sioux Falls South Dakota
    Posts
    358
    Default
    Quote Originally Posted by Cynthia_R View Post
    I am a little confused please correct me. I read that code 90656 should be used for the influenza immunization this year 2010 because H1N1 was included in the vaccine. Is this correct...I have been currently using 90658...Please advise. Thanks!
    H1N1 is included as part of the seasonal influenza vaccine this year. Use code 90656 for the preservative free, and 90658 if not the preservative free. Check to see which kind you received from the manufacturer. We are multiple clinics, and some have received one kind, and some the other.

    Hope this helps,
    Lucinda (Cindy) McGarry, CPC-P
    Applications Specialist
    Avera Health Plans
    Education Office Sioux Falls SD Local Chapter
    Past President Sioux Falls SD Local Chapter

  6. #16
    Smile Influenza 2010 new vaccine code
    Hey there ! I found this on the NC BCBS web site http://www.bcbsnc.com/content/provid.../oct8-2010.htm
    It says to use 90658 for someone who is over 3 yrs of age , this is for the preservative ,you'll have to look up the preservative free I don't have my books at home. Not 90668. This is the best thing I've found so far, our office has billed 90668 and no one is paying it so who knows . It's been really hard to get anyone to tell you what your suppose to use ! Hope this helps !
    Last edited by jenniferls; 11-08-2010 at 08:12 PM.

  7. #17
    Default
    If you go to the link i posted bcbs does say in black and white to use 90658 for the (trivalent) which is 2other types of influenza and h1n1 this years vaccine these other codes 90668 are for a pandemic (outbreak)

  8. #18
    Default
    Well...that cleared that up!

  9. #19
    Default
    we are new to giving flu shots so you are saying to use
    icd 9 code: V04.81
    E&M
    vaccine 90655
    admin 90465

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