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Coding for the 2010 Flu Shot: Three Vaccines, One Code

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H1N1 and Flu Vaccine Coding Made Easy

Vaccination protection influenzaThis year’s flu vaccine has been selected by the US Food and Drug Administration (FDA) to contain three vaccines in one single shot which makes medical billing a breeze this season.  The FDA has determined that one single flu shot containing vaccines for the H1N1, H3N2 and B/Brisbane influenza viruses should be sufficient to ward off this coming season’s most common circulating viruses and to protect the community.  A single flu shot means a single code which eliminates last minute medical billing confusion like last year’s H1N1 outbreak.[pullquote]Reimbursement will vary with each insurance company [/pullquote]The guidelines for getting the flu vaccine (http://www.cdc.gov/vaccines/pubs/vis/downloads/vis-flu.pdf) indicate that although everyone should get the flu shot, it is especially important for high risk patients (including young children, pregnant women, people age 50 and older, long term care facility residents, and health care providers).  There is a high expectation of patients requesting the flu vaccine this season, and we’ve provided the medical billing basics below.  Reimbursement will vary with each insurance company and should be researched thoroughly before billing out for the flu vaccine.

Influenza Vaccine Billing Guidelines

Use one of the following CPT codes and one of the Immunization Administration codes plus diagnosis V04.81 (Prophylactic vaccination and inoculation against influenza) to bill for reimbursement:

Coding The Flu Shot

CPT Codes:

90655 Influenza Virus Vaccine, split virus, preservative free (children 6 – 35 months)

90656 Influenza Virus Vaccine, split virus, preservative free (ages 3 and older)

90657 Influenza Virus Vaccine, split virus (children 6 – 35 months)

90658 Influenza Virus Vaccine, split virus (ages 3 and older)

90662 Influenza Virus Vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content

Immunization Administration Codes:

90465 Immunization administration younger than 8 years of age, first injection

90466 Immunization administration younger than 8 years of age, each additional injection (bill this only in addition to primary administration codes 90465, 90467)

90471 Immunization administration, 1 vaccine (single or combination vaccine/toxoid)

90472 Immunization administration, each additional vaccine (bill this only in addition to primary administration codes 90471, 90473)

G0008 Administration of Influenza virus vaccine for Medicare patients

Coding The Flu Vaccine Nasal Spray

CPT Code:

90660 Influenza Virus Vaccine, live, intranasal

Immunization Administration Codes:

90467 Immunization administration by intranasal or oral route; younger than 8 years of age

90468 Immunization administration by intranasal or oral route; younger than 8 years of age, each additional administration (bill this only in addition to primary administration codes 90465, 90467)

90473 Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

90474 Immunization administration by intranasal or oral route; each additional vaccine (bill this only in addition to primary administration codes 90471, 90473)

Flu Shot Coding Examples

  • A patient 65 years old with Medicare coverage who received a flu shot should be billed as follows:
  • 90656 dx V04.81
  • G0008 dx V04.81
  • A patient 35 years old with commercial insurance coverage who received the flu nasal spray should be billed as follows:
  • 90660 dx V04.81
  • 90743 dx V04.81

 

Additional Resources
www.flu.gov
http://www.cdc.gov/flu/

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Disclaimer

The analysis of any medical billing or coding question is dependent on numerous specific facts -- including the factual situations present related to the patients, the practice, the professionals and the medical services and advice. Additionally, laws and regulations and insurance and payer policies (as well as coding itself) are subject to change. The information that has been accurate previously can be particularly dependent on changes in time or circumstances. The information contained in this web site is intended as general information only. It is not intended to serve as medical, health, legal or financial advice or as a substitute for professional advice of a medical coding professional, healthcare consultant, physician or medical professional, legal counsel, accountant or financial advisor. If you have a question about a specific matter, you should contact a professional advisor directly.

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