Influenza Vaccine Administration and Its Coding for 2018-2019

by | Published on Oct 3, 2018 | Podcasts, Medical Coding (P) | 0 comments

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Outsource Strategies International (OSI), a Managed Outsource Solutions company is experienced in providing innovative medical billing and coding services that help physician practices run more efficiently.In today’s podcast, Natalie Tornese, one of our Senior Solutions Managers will discuss about influenza vaccine administration and how to code it with CPT and HCPCS codes.

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Hello and welcome to our podcast series. This is Natalie Tornese, Senior Solutions Manager at Outsource Strategies International. So, its flu season and I figured I would do a podcast on some of the coding changes that are taking place, you know, in regard to the flu. As you know, the flu season in the U.S. runs from October to May and peaks between December and February. The last flu season was one of the deadliest in history and claimed 80,000 lives according to the Centers for Disease Control and prevention. The flu can affect anybody, though it can be more dangerous for young children, adults ages 65 and older, those with underlying health conditions, and of course pregnant women. Physicians recommend that every six months and older get vaccinated, and that high-risk patients get vaccinated before October. Practitioners should update their influenza vaccine codes for the 2018-2019 season.

The flu vaccine is available as a flu shot and a nasal flu spray. The CDC has announced the following changes which I’m going to discuss regarding 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) vaccines.
  • LAIV is approved for use in non-pregnant individuals, 2 years through 49 years of age. There is a precaution however 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 also 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 “FluarixQuadrivalent” and for Afluria Quadrivalent was changed to be consistent with FDA-approved labeling.
    • For FluarixQuadrivalent, it is from 3 years and older to 6 months and older and
    • For Afluria Quadrivalent – from 18 years old and older to 5 years and older

So those are some of the changes. The recent AAPC report provides the influenza virus vaccine codes for the 2018-2019 season. So, these are the actual vaccine codes which are – G0008 which is administration of influenza virus vaccine. It is for the seasonal influenza virus vaccine and the ICD-10 code Z23 Encounter for immunization is the code to indicate a diagnosis for reimbursement purposes.

I’m going to include a transcript of all associated CPT codes for this upcoming season with all the labeler names and drug names along with this podcast. Please note that the effective dates for the vaccines are August 1, 2018 to July 31, 2019.

Note that my transcript will not include the CPT code 90689 Influenza virus vaccine quadrivalent inactivated, adjuvanted, preservative free, for intramuscular use as that code will not be effective until  January 1, 2019.

Flu viruses are constantly changing and flu vaccines are reviewed annually and updated to provide consistent protection against common circulating flu viruses.

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 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 any 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 suitable. I’m sorry, are not a substitute for vaccination.

Medicare and commercial health insurances companies reimburse physicians for the vaccine as well as the administration. Medicare covers the flu vaccine once per season (or more, if medically necessary); there’ll be no out of pocket costs associated with this for the patient. I hope this helps you know, but always remember that proper documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed. Thank you so much for listening.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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