Author Topic: 2010 Flu Shots  (Read 1310 times)

MJ

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2010 Flu Shots
« on: October 11, 2010, 11:37:45 AM »
Will you please give us a quick run-down on proper coding for this years flu shots.  I understand that the H1N1 and the flu vaccine are combined.  Is there a new CPT for this?  Last year the H1N1 was state supplied and we only charged for the administration.  Is that the case this year also?  Have Medicare administration codes stayed the same?

oneround

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Re: 2010 Flu Shots
« Reply #1 on: October 11, 2010, 04:08:48 PM »

Question: How do I report administration of the seasonal flu virus vaccine when provided at the same patient encounter as the initial H1N1 vaccine administration?

Answer: In the event that a seasonal flu vaccination is administered in addition to the H1N1 vaccination at the same visit, code 90470 should be reported for the initial administration service for the H1N1 vaccine product and either report code 90466, 90468, 90472, or 90474 for the additional administration service. Since these codes are add-on codes, modifier 51 does not apply to these services and should not be reported with these codes.

The H1N1 vaccine administration code should not be reported in addition to the initial service vaccine administration codes 90465, 90467, 90471, and 90473. To reiterate, these changes were made after the publication of the CPT 2010 codebook. Therefore, the instructional notes following the add-on vaccine administration codes have not been updated to include code 90470 in the primary procedures list. However, appropriate reporting of multiple vaccine administrations is to report one initial vaccine 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 (www.ama-assn.org/ama/pub/H1N1/vaccination-information.shtml) for a list of payer billing requirements.

For face-to-face physician counseling of the patient and family during the pediatric administration of a vaccine, the following codes are reported according to the route of administration in addition to the initial service code 90470:

+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 under 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)

For immunization administration of any vaccine that is not accompanied by face-to-face physician counseling to the patient/family, without limit on the age of the patient, the following codes are reported according to the route of administration in addition to code 90470:

+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)

+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)

"CPT Assistant  October 2009, Volume 19, Issue 10, pages 3-5

ANSWER-- Currently, there is a general pandemic vaccine code 90663, Influenza virus vaccine, pandemic formulation, that is appropriate for reporting the H1N1 vaccine product. The appropriate immunization administration code 90470, H1N1 immunization administration (intramuscular, intranasal), including counseling when performed, may be reported in conjunction with 90663 for the administration of the vaccine.

 

Effective October 1, 2009, two (2) new Level II HCPCS codes were created by the Centers for Medicare & Medicaid Services (CMS) for the reporting of the H1N1 vaccine and administration of the vaccine. The new HCPCS codes are G9141, Influenza A (H1N1) immunization administration (includes the physician counseling the patient/family), and G9142, Influenza A (H1N1) vaccine, (any route of administration). Additional information regarding the H1N1 virus and the associated vaccine can be found in Transmittal 1803, CR 6626 at www.cms.hhs.gov/

 

Please note that while there are two HCPCS G codes (G9141 for the administration and G9142 for the vaccine itself), only HCPCS code G9141 is separately payable under the OPPS. HCPCS code G9142 (vaccine code) is not reportable under the OPPS because the vaccine is supplied at no cost to the provider."

Here is a good  site for getting paid on vaccines

http://www.aafp.org/online/en/home/clinical/immunizationres.html?navid=immunizations?intcmp=10004-ca-44
« Last Edit: October 11, 2010, 04:12:19 PM by oneround »
Michael A. Reynolds, CPC, CCP-P, CPMB, OS
Project Manager
Corporate Compliance
Sharp HealthCare

midwifebiller

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Re: 2010 Flu Shots
« Reply #2 on: October 23, 2010, 09:52:29 PM »
Thank you!  I copied the entire message and sent it to all of our billers.
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com