Flu is a viral respiratory illness that spreads very easily and it can lead to serious health complications and possibly death. With flu season just around the corner, it is important to be prepared to deal with this highly contagious condition. The Centers for Disease Control and Prevention (CDC) recommends the annual seasonal flu vaccine as the best way to help protect against flu. Each year, influenza viruses change slightly, making the vaccine used in previous years ineffective. Therefore, the composition of U.S. flu vaccines is reviewed and updated annually to more closely match currently circulating virus strains. Healthcare providers need to stay up-to-date on the latest influenza vaccine recommendations. Medical coding outsourcing is a practical option to code for influenza vaccine this flu season.
According to the CDC, flu vaccines protect against the three or four viruses (depending on the vaccine) that research suggests will be most common. For 2019-2020, trivalent (three-component) influenza vaccines contain:
- A/Brisbane/02/2018 (H1N1)pdm09-like virus (updated)
- A/Kansas/14/2017 (H3N2)-like virus (updated)
- B/Colorado/06/2017-like (Victoria lineage) virus
The American Academy of Professional Coders (AAPC) reports that the 2019-20 U.S. quadrivalent influenza vaccines would contain HA derived from these three viruses and an additional influenza B virus HA, a B/Phuket/3073/2013-like virus (Yamagata lineage). Compared with the 2018-19 season, the composition for 2019-20 represents updates in the influenza A(H1N1)pdm09 and influenza A(H3N2) components of the vaccine. Healthcare providers should prepare for the flux of injections by updating their billing systems with the 2019 Average Sales Price (ASP) Drug Pricing files and reading the latest vaccine recommendations.
CPT Vaccine Codes 2019-2020
CPT vaccine codes for the 2019-2020 flu season are as follows:
- 90653: Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use
- 90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
- 90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
- 90674: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use
- 90682: Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, 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
- 90756: Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use
Using the right ICD-10 codes for influenza is necessary to demonstrate the severity of the patient’s illness.
CDC’s Recommendations for the 2019-2020 Flu Season
- Routine annual influenza vaccination of all persons aged ≥6 months who do not have contraindications continues to be recommended
- The American Academy of Pediatrics (AAP) no longer expresses a preference for the flu shot over nasal spray vaccine for children during the 2019-2020 flu season
- The AAP recommends using the flu shot (inactivated influenza vaccine, IIV) as the primary vaccine choice
The AAPC highlights two recent regulatory actions:
- “In October 2018, the FDA approved an expanded age indication for Afluria Quadrivalent (IIV4). Previously licensed for persons aged ≥5 years, Afluria Quadrivalent (IIV4) is now licensed for persons aged ≥6 months. The dose volume is 0.25 mL per dose (containing 7.5 µg of hemagglutinin (HA) per vaccine virus) for children aged 6 through 35 months and 0.5 mL per dose (containing 15 µg of HA per vaccine virus) for all persons aged ≥36 months (≥3 years)”.
- “In January 2019, the FDA approved a change in dose volume for Fluzone Quadrivalent (IIV4). Previously, the dose volume for children aged 6 through 35 months was 0.25 mL (containing 7.5 µg of HA per vaccine virus). Children aged 6 through 35 months who receive Fluzone Quadrivalent may now receive either 0.25 mL (containing 7.5 µg of HA per vaccine virus) or 0.5 mL (containing 15 µg of HA per vaccine virus) per dose. Children aged ≥36 months (≥3 years) and adults should receive 0.5 mL per dose”.
According to the Centers for Medicare & Medicaid Services (CMS), all physicians, non-physician practitioners, and suppliers who administer influenza virus and the pneumococcal vaccinations must take assignment on the claim for the vaccine.
Flu season usually begins in October and can last as late as May. Experts recommend getting vaccinated as early as possible, so that when or if you are exposed to an infection, you are protected. It generally takes about two weeks for the vaccine to produce a sufficient antibody response against the flu.
This fall, federal officials have announced that 70 million flu shots are being delayed, but medical experts suggest this could actually help rather than hinder vaccinations for this year’s influenza season (www.healthline.com). The delay is mainlydue to a reformulation of the flu shots, which affects Fluzone Quadrivalent, Fluzone High-Dose, and Flublok Quadrivalent, which together account for about 40 percent of the market. Healthline reports that Dr. J. Leonard Lichtenfeld, MACP, the interim chief medical and scientific officer at the American Cancer Society says that the delay occurred because experts waited a few weeks to make sure they chose the best vaccine they could. Instead of a shortage, it would mean a more effective vaccine.
Providers can rely on experienced medical billing company to ensure accurate billing of influenza vaccines, which is indispensable for timely and appropriate reimbursement.
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.