As the current flu season worsens, accurate vaccine coding is necessary for effective medical billing and accounting of services provided. Since influenza is constantly developing new viral strains, constant development of updated flu vaccines is vital. To keep up with this, the American Medical Association (AMA) publishes new and revised vaccine codes twice a year (January and July) when required for emergent/critical distribution, which is known as early release. These codes are indicated with a symbol and the AMA will track them to monitor the FDA approval status. The symbol will be removed from the codes once they get the approval. Let’s take a look into early release vaccine codes of this year.
The two new influenza vaccine codes that will be available to code for vaccinations from February 1, 2015 are as follows:
- 90620: Meningococcal recombinant protein and outer membrane vesicle vaccine, Serogroup B, 2 dose schedule, for intramuscular use
- 90621: Meningococcal recombinant lipoprotein vaccine, Serogroup B, 2 or 3 dose schedule, for intramuscular use
The following vaccine code has received FDA approval.
- 90630: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
Though not an influenza vaccine, the following vaccine code will be active as of January 1, 2015.
- 90697: Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenza type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP- IPV-Hib-HepB), for intramuscular use
An additional 48 vaccine codes in the 90632-90748 range are also revised, which will be effective from July 2015. These include minor descriptor revisions that clarify terminology, but not changing proper code application. Also, additional format edits are included for 90647, 90648, 90696, 90702, 90714, and 90721.
Proper Vaccine Coding
To assign the right CPT codes for vaccines/toxoids, it is necessary to code the administration codes apart from the vaccine codes. The use of administration codes are as follows:
- When a physician or qualified healthcare professional (QHP) provides face-to-face counseling of the patient/family during the administration of a vaccine, administration codes 90460 and 90461 should be used
- When the immunization is not accompanied by a face-to-face visit with a physician or QHP, the codes 90471-90474 must be used if the patient is over 18 years of age
Do not use modifier 51 with vaccine/toxoid administration procedures. If E/M services are performed at the same encounter, the proper E/M service code should be included. Don’t forget to note the codes that are age specific. There are separate codes available for combination vaccines and you cannot code combination vaccines separately. ICD-9-CM includes codes that allow the physician to report vaccinations that have not been administered such as:
- V64.05: Vaccination not carried out because of caregiver refusal
- V64.06: Vaccination not carried out because of patient refusal
- V64.07: Vaccination not carried out for religious reasons
As the Affordable Care Act (ACA) included preventive care services in their essential health benefits that must be covered by all Marketplace plans, many practices may see an increasing number of patients coming for vaccinations. Practices struggling to provide care for an overwhelming number of patients can consider obtaining medical coding support from professional medical billing and coding companies and benefit from efficient claim processing and timely reimbursement. Physicians teaming up with a reliable outsourcing firm will be relieved of their cumbersome administrative work and can focus on their core responsibilities including the provision of quality care.
Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.