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Listen to this podcast on flu vaccine codes for the 2017-2018 season. In this podcast, Natalie Tornese, one of the senior solutions managers at OSI, discusses how to assign the right ICD-10 codes for influenza and associated conditions.

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Hello everyone and welcome to our podcast series. I’m Natalie Tornese, one of the senior solutions managers at Outsource Strategies International. Let’s talk about the flu.

The flu season is in full swing and the latest Centers for Disease Control and Prevention (CDC) report is that flu activity continues to rise. Immunization is the most effective way to prevent influenza illness and its complications. There have been a couple of changes that providers need to be aware of when billing and coding for flu vaccine.

The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Traditional flu vaccines called trivalent vaccines are made to protect against three flu viruses: two influenza A viruses (H1N1) and (H3N2), and an influenza B virus. There are also flu vaccines made to protect against four flu viruses called quadrivalent vaccines. These vaccines protect against the same viruses as the trivalent vaccine, with the addition of another B virus.

The CDC recommends injectable influenza vaccines (including inactivated influenza vaccines and recombinant influenza vaccines) during the 2017-2018 season. Both trivalent (three-component) and quadrivalent (four-component) flu vaccines will be available.

Trivalent flu vaccines include the following:

Those are the different types of flu shots. Well, what’s new this flu season?
  • Well, the recommendation not to use the nasal spray flu vaccine (LAIV) was renewed for the 2017-2018 season. Only injectable flu shots are recommended for use again this season.
  • Pregnant women may receive any licensed, recommended, and age-appropriate flu vaccine. However, there is some concern about administration of the flu shot during the first trimester.
  • Two new quadrivalent (four-component) flu vaccines have been licensed: one inactivated influenza vaccine ("AfluriaQuadrivalent" IIV) and one recombinant influenza vaccine ("Flublok Quadrivalent" RIV).
  • The age recommendation for "FlulavalQuadrivalent" has been changed from 3 years old and older, to 6 months and older to be consistent with FDA-approved labeling.
  • The trivalent formulation of Afluria is recommended for people 5 years and older, which changed (from 9 years and older) in order to match the FDA administration package insert.
  • CMS released a quarterly vaccine code update in January of 2018 regarding the new influenza vaccine code 90756. This new influenza virus vaccine code has been implemented for DOS (date of service) on or after January 1, 2018.

Code 90756 is an influenza virus vaccine, quadrivalent, derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use.

Keep in mind that this code is not retroactive. Claims will not be accepted that contain the influenza virus vaccine code 90756 between the DOS of August 1, 2017, and December 31, 2017. If these claims are received in January of 2018 containing this code 90756, they will be rejected or returned as un-processable. It is in these cases that MACS would use the existing Q2039 code.

For more information, you can review the MLN matters MM10196-revised

The Medicare Annual Part B deductible and coinsurance amounts do not apply for these vaccinations. All physicians, practitioners, and suppliers who administer these vaccines must take assignment on the claim for the vaccine.

The administration of immunizations is reported in addition to the vaccine product code. Don’t forget your administration codes. Be sure to use code G0008 for reporting the influenza vaccine administration. This is for Medicare patients. For most other payers, when you are billing for the administration of the vaccine, you would report codes 90460 (that’s for patients under 18  with counseling regarding the influenza immunization). Or, you can use 90471-90472. You use 90471 for the first or only vaccine administered, and 90472 when administered subsequent to another vaccine on the same date.

Being that there are so many CPT codes for the influenza vaccine, accurate coding is critical. Coding is based on the product you are using.  Please review the transcript for a link to the CPT as well as the administration codes below.

ICD-10-CM code Z23 is reported for all immunizations and may be reported as a secondary diagnosis when immunizations are provided in conjunction with a routine health exam.

Remember that for ICD 10 diagnostic codes, additional codes should be used, if applicable, to identify any manifestations or associated conditions.  I can say a thousand times, please remember to only assign what the clinicians document. A list of all influenza and associated ICD 10 codes can be found in the transcript below as well.

I hope this helps, but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening.

CPT CODES

Influenza Vaccine Products for the 2017–2018 Influenza Season - http://www.immunize.org/catg.d/p4072.pdf

ICD-10 Codes for Influenza and pneumonia

Excludes 2: allergic or eosinophilic pneumonia (J82) aspiration pneumonia NOS (J69.0) meconium pneumonia (P24.01) neonatal aspiration pneumonia (P24.-) pneumonia due to solids and liquids (J69.-) congenital pneumonia (P23.9) lipid pneumonia (J69.1) rheumatic pneumonia (I00) ventilator associated pneumonia (J95.851)

  • J09 Influenza due to certain identified influenza viruses
  • J10 Influenza due to other identified influenza virus
  • J11 Influenza due to unidentified influenza virus
  • J12 Viral pneumonia, not elsewhere classified
  • J13 Pneumonia due to Streptococcus pneumoniae
  • J14 Pneumonia due to Hemophilus influenzae
  • J15 Bacterial pneumonia, not elsewhere classified
  • J16 Pneumonia due to other infectious organisms, not elsewhere classified
  • J17 Pneumonia in diseases classified elsewhere
  • J18 Pneumonia, unspecified organism

Here are the details of the key codes in this set:

  • J09 Influenza due to certain identified influenza viruses
    Excludes 1: influenza due to other identified influenza virus (J10.-) influenza due to unidentified influenza virus (J11.-) seasonal influenza due to other identified influenza virus (J10.-) seasonal influenza due to unidentified influenza virus (J11.-)

    • J09.X1 Influenza due to identified novel influenza A virus with pneumonia
      Inclusion Terms: Avian influenza; Bird influenza; Influenza A/H5N1; Influenza of other animal origin, not bird or swine; Swine influenza virus (viruses that normally cause infections in pigs).
      Note: For J09.X1, it would be necessary to code also, if applicable, for associated lung abscess (J85.1) other specified type of pneumonia.
    • J09.X2 Influenza due to identified novel influenza A virus with other respiratory manifestations
      Inclusion Terms: Influenza due to identified novel influenza A virus NOS; Influenza due to identified novel influenza A virus with laryngitis; Influenza due to identified novel influenza A virus with pharyngitis; Influenza due to identified novel influenza A virus with upper respiratory symptoms;
    • J09.X3 Influenza due to identified novel influenza A virus with gastrointestinal manifestations
      Excludes 1: ‘intestinal fu’ [viral gastroenteritis] (A08.-)
    • J09.X9 Influenza due to identified novel influenza A virus with other manifestations
      Inclusion Terms: Influenza due to identified novel influenza A virus with encephalopathy; Influenza due to identified novel influenza A virus with myocarditis; Influenza due to identified novel influenza A virus with otitis media
  • J10 Influenza due to other identified influenza virus
    Excludes 1: influenza due to avian influenza virus (J09.X-); influenza due to swine fu (J09.X-); influenza due to unidentified influenza virus (J11.-)
    If applicable, code also: associated lung abscess (J85.1)

    • J10.00 Influenza due to other identified influenza virus with unspecified type of pneumonia
    • J10.01 Influenza due to other identified influenza virus with the same other identified influenza virus pneumonia
    • J10.08 Influenza due to other identified influenza virus with other specified pneumonia
    • J10.1 Influenza due to other identified influenza virus with other respiratory manifestations
      Inclusion Terms: Influenza due to other identified influenza virus NOS Influenza due to other identified influenza virus with laryngitis Influenza due to other identified influenza virus with pharyngitis Influenza due to other identified influenza virus with upper respiratory symptoms
    • J10.2 Influenza due to other identified influenza virus with gastrointestinal manifestations
      Inclusion Terms: Influenza due to other identified influenza virus gastroenteritis
      Excludes 1: intestinal flu’ [viral gastroenteritis] (A08.-)
    • J10.8 Influenza due to other identified influenza virus with other manifestations
      • J10.81 Influenza due to other identified influenza virus with encephalopathy
      • J10.82 Influenza due to other identified influenza virus with myocarditis
      • J10.83 Influenza due to other identified influenza virus with otitis
  • J11 Influenza due to unidentified influenza virus
    • J11.0 Influenza due to unidentified influenza virus
      • J11.00 Influenza due to unidentified influenza virus with unspecified type of pneumonia
        Inclusion Terms: Influenza with pneumonia NOS
      • J11.08 Influenza due to unidentified influenza virus with specified pneumonia
        Also code: other specified type of pneumonia.
    • J11.1 Influenza due to unidentified influenza virus with other respiratory manifestations
      Inclusion Terms: Influenza NOS; Influenza laryngitis NOS; Influenza pharyngitis NOS; Influenza with upper respiratory symptoms NOS
    • J11.2 Influenza due to unidentified influenza virus with gastrointestinal manifestations
      Inclusion Terms: Influenza gastroenteritis NOS
      Excludes 1: ‘intestinal fu’ [viral gastroenteritis] (A08.-)
    • J11.8 Influenza due to unidentified influenza virus with other manifestations
      • J11.81 Influenza due to unidentified influenza virus with encephalopathy
        Inclusion terms: Influenza encephalopathy NOS
      • J11.82 Influenza due to unidentified influenza virus with myocarditis
        Inclusion terms: Influenza myocarditis NOS
      • J11.83 Influenza due to unidentified influenza virus with otitis media Inclusion terms: Influenza otitis media NOS
      • J11.89 Influenza due to unidentified influenza virus with other manifestations
  • J12 Viral pneumonia, not elsewhere classifiedFirst code: associated influenza, if applicable (J09.X1, J10.0-, J11.0-)
    Also code: associated abscess, if applicable (J85.1)
    Includes: bronchopneumonia due to viruses other than influenza viruses aspiration pneumonia due to anesthesia during labor and delivery (O74.0)
    Excludes 1: aspiration pneumonia due to anesthesia during pregnancy (O29); aspiration pneumonia due to anesthesia during puerperium (O89.0); aspiration pneumonia due to solids and liquids (J69.-); aspiration pneumonia NOS (J69.0); congenital pneumonia (P23.0); congenital rubella pneumonitis (P35.0); interstitial pneumonia NOS (J84.9); lipid pneumonia (J69.1); neonatal aspiration pneumonia (P24.-); J12.0 Adenoviral pneumonia.

    • J12.1 Respiratory syncytial virus pneumonia
    • J12.2 Parainfluenza virus pneumonia
    • J12.3 Human metapneumovirus pneumonia
    • J12.8 Other viral pneumonia
      • J12.81 Pneumonia due to SARS-associated coronavirus
        Inclusion Terms: Severe acute respiratory syndrome NOS
      • J12.89 Other viral pneumonia
    • J12.9 Viral pneumonia, unspecified