The goal of immunization providers is to ensure that vaccines reach all people who need them. Accurate vaccine coding increases opportunities for enhanced/appropriate reimbursement, reduces audit and liability risks, and improves information flow. Various vaccine code changes have come into effect starting January 1, 2017. Expert medical coding services are available to help providers keep track of these updates, plan for the implementation of the new and revised codes and submit accurate claims.
Highlights of Vaccine Coding Updates 2016-2017
- Revisions to age specifications in influenza code descriptors: Codes 90655-90658, 90661, and 90685-90688 have been revised to include dosage in place of age in their descriptors. The American Academy of Pediatrics (AAP) gives the revised codes as follows:
Revised Influenza codes 2016 – Age of Patient January 1, 2017 – Dosage 90655, 90657, 90685, and 90687 6-35 months 0.25 mL 90656, 90658, 90686, 90688 Older than 3 years 0.5 mL - 90655 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90656 Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90657 Influenza virus vaccine, trivalent (IIV3), split virus, 0.25 mL dosage, for intramuscular use
- 90658 Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use
- 90661 Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90685 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL dosage, for intramuscular use
- 90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use
- 90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
- 90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use
- Revision of descriptor for code 90661: CPT code 90661 has been revised to clarify that it represents a trivalent vaccine and to differentiate this vaccine from a quadrivalent product. Formerly, 90661 was used for flucelvax.
- New code 90674: This new influenza code – flucelvax – which came into effect on January 1, 2017 represents quadrivalent cell cultured influenza vaccine indicated for use in those 4 years of age and older:
- 90674 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- Vaccine Administration Codes 90460-90474: For proper billing and payment, each vaccination claim needs two codes: an administrative code and a vaccine code. Vaccine administration codes are selected based on what vaccines were administered and how many vaccinations were given, the route of administration, the number of components in each vaccine, and whether or not the physicians provided counseling. The vaccine administration codes are:
- 90460 – Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered.
- 90461 – Each additional vaccine or toxoid component administered (to be listed separately in addition to code for primary procedure.
- 90471 – Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
- 90472 – Each additional vaccine (single or combination vaccine/toxoid) (to be listed separately in addition to code for primary procedure
- 90473 – Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
- 90474 – each additional vaccine (single or combination vaccine/toxoid) (to be listed separately in addition to code for primary procedure)
When reporting the administration of a vaccine, the evaluation and management (E/M) code separately, if appropriate. Modifier 25 should be appended to the E/M code, as needed.
- Revisions to medically unlikely edits (MUEs): Increase in the number of units of service allowed for vaccine administration has impacted two codes:
- For 90460 MUEs have been revised from 6 to 9 with effect from April 1, 2017
- For 90461, MUEs have been revised from 5 to 8 with effect from July 1, 2016
- Vaccine Coverage for Medicare Part B: G0008 – administration of influenza virus vaccine: Administration of influenza vaccine to Medicare patients should be done using the Health Care Common Procedure Coding System (HCPCS) code G0008.Note: Under Medicare’s policy, code 99211 (an E/M service not requiring a physician’s presence) is not allowed on the same date as immunization administration.
- ICD-10 Code for immunization: Z23 – encounter for immunization: Z23 is the appropriate ICD-10-CM code for influenza vaccine administration and should be linked to both the vaccine product code and administration code for each immunization.
Implementing Vaccine Code Changes
Physician coding companies closely monitor the release and implementation dates posted and help practices plan for incorporating the new and revised vaccine codes. If there are improper denials of vaccine products that have new or revised codes, a reliable medical billing and coding company will appeal denied claims submitted with appropriate codes. Their expert coding team will use the latest coding resources to help physicians optimize reimbursement for immunization services.
Rajeev Rajagopal, the President of OSI, has a wealth of experience as a healthcare business consultant in the United States. He has a keen understanding of current medical billing and coding standards.