The flu season in the United States runs from October to May, and peaks between December and February. The 2017-2018 flu season was one of the deadliest in the history of the nation and claimed 80,000 lives, according to the Centers for Disease Control and Prevention (CDC). The flu can affect anybody, though it can be more dangerous for young children, adults aged 65 and over, those with underlying health conditions, and pregnant women. Physicians recommend that everyone six months and older get vaccinated, and that high-risk patients get vaccinated ahead of October. Practitioners should update their influenza vaccine codes for the 2018-2019 season. Outsourcing medical coding can help health care providers report influenza vaccine codes correctly and ensure reimbursement for the vaccine and its administration.
2018-19 CDC Guidance for the Flu Season
The flu vaccine is available as a flu shot and a nasal flu spray. The CDC has announced the following changes for the 2018-19 flu season:
- To better match circulating viruses, the B/Victoria component was changed and the influenza A (H3N2) component was updated
- The nasal spray flu vaccine (live attenuated influenza vaccine or “LAIV”) continues to be the recommended option for influenza vaccination of persons for whom it is otherwise appropriate. All LAIV will be quadrivalent (four-component).
- LAIV is approved for use in non-pregnant individuals, 2 years through 49 years of age. There is a precaution against the use of LAIV for people with certain underlying medical conditions.
- Most regular-dose egg-based flu shots will be quadrivalent.
- All recombinant vaccine will be quadrivalent.
- Cell-grown flu vaccine will be quadrivalent. The influenza A (H3N2) and both influenza B reference viruses will be cell-derived, and the influenza A (H1N1) will be egg-derived.
- Intradermal flu vaccines will not be available.
- The age recommendation for “Fluarix Quadrivalent” and for Afluria Quadrivalent was changed to be consistent with Food and Drug Administration (FDA) – approved labeling:
- For Fluarix Quadrivalent – from 3 years old and older to 6 months and older
- For Afluria Quadrivalent – from 18 years old and older to 5 years old and older
2018-19 CPT Coding Updates for Vaccinations
A recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season:
- HCPCS Level II G0008 Administration of influenza virus vaccine is the administration code for the seasonal influenza virus vaccine
- ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes
The CPT codes for the 2018-2019 flu vaccines with labeler name and drug name are as follows:
- 90653 Seqirus Inc – Fluad
- 90656 Seqirus Inc – Afluria
- 90662 Sanofi Pasteur – Fluzone High-Dose
- 90674 Seqirus Inc – Flucelvax Quadrivalent
- 90682 Sanofi Pasteur – Flublok Quadrivalent
- 90685 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90686 Seqirus Inc, GlaxoSmith, Kline Sanofi Pasteur – Afluria Quadrivalent, Fluarix Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent [Preservative Free]
- 90687 Sanofi Pasteur – Fluzone Quadrivalent Pediatric
- 90688 Seqirus Inc, GlaxoSmithKline, Sanofi Pasteur – Afluria Quadrivalent, Flulaval Quadrivalent, Fluzone Quadrivalent
- 90756 Seqirus Inc – Flucelvax Quadrivalent
- Q2035 Seqirus Inc – Afluria
The effective dates for these vaccines are 08/01/2018 – 07/31/2019.
Point to note: The above list does not include CPT code 90689 Influenza virus vaccine quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use. This code is not effective until January 1, 2019.
2018-2019 Flu Vaccines – Consistent Protection against Common Viruses
Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses. According to Flu.gov, flu injections protected five million people against the flu last year. For 2018-2019:
Trivalent vaccines are recommended to contain the following:
- A/Michigan/45/2015 (H1N1)pdm09-like virus
- A/Singapore/INFIMH-16-0019/2016 A (H3N2)-like virus (updated)
- B/Colorado/06/2017-like (Victoria lineage) virus (updated)
Quadrivalent vaccines are recommended to contain:
- The three recommended viruses above as well as B/Phuket/3073/2013-like (Yamagata lineage) virus
Flu Vaccine Recommendations for Children
As of August 18, 2018, up to 179 children died of influenza-associated illnesses, and thousands were hospitalized. According to the CDC, about 80 percent of the children who died had not received a flu vaccination. The recommendations of the American Academy of Pediatrics (AAP) are as follows:
- The injectable flu vaccine is the primary option for children since it has provided the most consistent protection against all strains of the flu virus in recent years.
- All children 6 months and older should receive the flu shot as soon as it becomes available, preferably by the end of October.
- The nasal spray can be used for children who would not otherwise receive the flu shot or refuse the flu shot, as long as they are 2 years of age or older and healthy without an underlying medical condition.
- The number of doses of influenza vaccine should be based on a child’s age and vaccine history.
- Children with egg allergy can receive influenza vaccine with no additional precautions than those considered for any vaccine
- Antiviral medications are important in the treatment and control of influenza, but are not a substitute for vaccination.
Billing Flu Vaccine Administration
Medicare and commercial health insurance companies reimburse physicians for the vaccine and its administration. Medicare covers the flu vaccine once per season (or more, if medically necessary) without any out-of-pocket cost to the patient. Outsourcing medical billing and coding can help providers code correctly for the vaccines administered and boost their immunization administration revenue. The steps involved are: billing the vaccine using the right CPT code, adding the diagnosis code, adding a National Drug Code (NDC) to identify the specific type of immunization the patient received, and billing for the immunization administration.