In the United States, the flu season starts during the fall, with influenza viruses increasing in October and November, and continuing to be active till as late as May. The best way to prevent the flu is by getting a flu vaccine, and this year, the Centers for Disease Control and Prevention (CDC) is encouraging people to get their flu shots as early as possible.
During the 2015-16 flu season, national influenza vaccination coverage decreased to 45.6% (about 144 million people), which was a 1.5 percentage point decrease compared with the 2014-15 season (47.1%). Considering influenza’s unpredictable nature, experts say that patients should get vaccinated by the end of October this year.
Influenza A and B are the two viruses that cause the yearly flu outbreaks. In the 2016-17 flu season, people will have only injectable flu shots and no nasal sprays. The vaccines will counter three or four viruses that are expected to be most common. The noteworthy points in the CDC’s immunization guidance for the 2016-2017 flu season are:
- Discontinuation of nasal spray: CDC does not recommend the use of the live-attenuated influenza vaccine offered as a nasal spray (FluMist) for this flu season since data showed that it was ineffective during the past seasons.
- A higher dose for older adults: One new option is a vaccine licensed for adults aged older than 65 years that contains an adjuvant. As immune defenses become weaker with age, older people are at a higher risk of severe illnesses from influenza. Aging also reduces the body’s ability to respond well to the influenza vaccine. Vaccines with a higher dose of antigen can produce a better immune response, and therefore, provide better protection against flu.
- New recommendations for people with egg allergies: Those with an egg allergy can safely take any age-appropriate flu shot in hospitals, clinics, health departments, and physician offices. People with egg allergies don’t have to wait 30 minutes after receiving their flu shot.
- Cell-based vaccine: A four-component shot made with a virus grown in cell culture rather than eggs is recommended for use in patients aged 4 years and older.
Gynecologist and obstetricians should also be on alert, warns the American College of Obstetricians and Gynecologists as pregnant women are six times more likely to die of flu complications than others are.
Physicians’ practices need to be up-to-date on the 2016-2017 CPT, HCPCS, and ICD-10-CM codes for flu vaccine, administration, and payment allowances. For 2017, a new code has been introduced and code descriptors have been revised to include dosage rather than age. Some of the new and revised CPT codes are:
90630 – Influenza split virus vaccine, quadrivalent (IIV4), preservative free, for intradermal use
90653 – Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use
90655 – Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 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
90672 – Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use
90688 – Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use
HCPCS Level II Code
Q2035 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
Q2036 – nfluenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
Q2039 – Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified)
ICD-10-CM diagnosis code Z23 should be reported for Encounter for immunization when a person receives both vaccines. However, separate administration codes should be reported for the seasonal influenza virus (G0008) and pneumococcal (G0009) vaccines. A separate roster claim has to be prepared for the pneumococcal vaccine and the seasonal influenza virus vaccine.
Professional medical coding companies provide efficient medical billing and coding services for physicians’ practices. Partnering with the right company will ensure adherence to the immunization guidelines for the 2016-2017 flu season for appropriate and timely reimbursement.