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MKT28186-1R 8/15

CODING FOR FLUZONE VACCINE

Coverage, coding and reimbursement policies vary significantly by insurer, plan, and patient. Information provided does not guarantee coverage, payment, or reimbursement from any insurer for procedures, services or products. Provider participation, patient eligibility, and medical necessity, as well applicable state and federal requirements may be used by insurers to determine whether reimbursement will be made when a claim is received.

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CODING FOR FLUZONE VACCINE

PROPER VACCINATION CODING  Document all vaccinations in patient’s medical record  Bill for each vaccine and its administration1,2 1. Vaccine code 2. Administration code 3. Diagnosis code  Terms: – We use the term “vaccine” to refer to the vaccine itself – We use “administration” to refer to the act of giving the vaccine to a patient – And we use “vaccination” to refer to the vaccine and its administration as one  Always keep staff aware of any product inventory or code changes

References: 1. American Academy of Pediatrics (AAP). Vaccines coding table. https://www.aap.org/en-us/professional-resources/practice-support/Coding-at-theAAP/Documents/Vaccine%20Coding%20Table.pdf. Accessed July 6, 2015. 2. Centers for Medicare & Medicaid Services (CMS). 2012-2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations: Steps to promoting wellness immunizations. http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf. Accessed July 6, 2015.

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INFLUENZA VACCINE CODE DISTINCTIONS AND TERMS1,2 Route of Administration “Intramuscular”

Virus

“Intradermal”

“Intranasal”

“Live”

High-Dose by Content

Adjuvanted

Dosage “6-35 months of age” 0.25-mL dose

“Enhanced immunogenicity via increased antigen content”

a

“Subunit”

“Split virus”

Preservative Content

Base

“Preservative-free”

“Derived from” ‘cell cultures’ or “RIV3”

“3 years of age and older” 0.50-mL dose

Number of Antigens “Trivalent”

“Quadrivalent”

RIV3 = recombinant hemagglutinin influenza vaccine, trivalent.

References: 1. American Medical Association (AMA). CPT® Category I Vaccine Codes. © 2015 American Medical Association. Last updated July 1, 2015. https://download.amaassn.org/resources/doc/cpt/x-pub/vaccine-code-desc.pdf. Accessed July 6, 2015. 2. AMA. CPT 2015 Standard Edition (Current Procedural Terminology [Standard]). Chicago, IL: American Medical Association; 2015.

CODING FOR FLUZONE HIGH-DOSE VACCINE

Vaccine

Age Indicationa

Fluzone High-Dose vaccine

65 years and older

Presentationa 0.5 mL single-dose syringe

11-Digit NDCb Package 49281-0397-65

11-Digit NDC Unit

Dosea

49281-0397-88 0.50 mL

CPT Code1,2

HCPCS Code3

90662

90662

High-Dose Code1,2 90662 Influenza virus vaccine (IIV),c split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use

a Information

from 2015 Full Prescribing Information for Fluzone vaccine; b NDC = National Drug Code; c IIV = Inactivated influenza vaccine.

References: 1. AMA. CPT 2015 Standard Edition (Current Procedural Terminology [Standard]). Chicago, IL: American Medical Association; 2015. 2. AMA. CPT® Category I Vaccine Codes. © 2015 American Medical Association. Last updated July 1, 2015. https://download.ama-assn.org/resources/doc/cpt/x-pub/vaccine-code-desc.pdf. Accessed July 6, 2015. 3. CMS. 2012-2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations: Steps to promoting wellness immunizations. http://www.cms.gov/Medicare/Prevention/ Immunizations/Downloads/2012-2013_Flu_Guide.pdf. Accessed July 6, 2015.

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CODING FOR FLUZONE INTRADERMAL QUADRIVALENT VACCINE Age Indicationa

Presentationa

Fluzone Intradermal Quadrivalent 18-64 years vaccine

0.1 mL single-dose microinjection

Vaccine

11-digit NDC Package

11-digit NDC Unit

Dosea

CPT Code1,2

HCPCS Code3

49281-0708-40

49281-0708-48

0.1 mL

90630

90630

Quadrivalent Intradermal Code1,2 90630 Influenza virus vaccine, quadrivalent (IIV4),b split virus, preservative free, for intradermal use

Trivalent Intradermal Code1,2 Do not use for 2015-2016 flu season! 90654 Influenza virus vaccine, trivalent (IIV3),c split virus, preservative free, for intradermal use a

Information from 2015 Full Prescribing Information for Fluzone vaccine; b IIV4 = Inactivated influenza vaccine quadrivalent; c IIV3 = Inactivated influenza vaccine trivalent.

References: 1. AMA. CPT 2015 Standard Edition (Current Procedural Terminology [Standard]). Chicago, IL: American Medical Association; 2015. 2. AMA. CPT® Category I Vaccine Codes. © 2015 American Medical Association. Last updated July 1, 2015. https://download.ama-assn.org/resources/doc/cpt/x-pub/vaccine-code-desc.pdf. Accessed July 6, 2015. 3. CMS. 2012-2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations: Steps to promoting wellness immunizations. http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf. Accessed July 6, 2015.

CODING FOR FLUZONE QUADRIVALENT VACCINE (INTRAMUSCULAR) Vaccine

Age Indicationa

Fluzone Quadrivalent vaccine (Pediatric Dose): Contains no preservative

6-35 months

Fluzone Quadrivalent vaccine: Contains no preservative

3 years and older

Fluzone Quadrivalent vaccine: Contains no preservative

3 years and older

Fluzone Quadrivalent vaccine

6 months and older

Presentationa 0.25 mL single-dose syringe 0.50 mL single-dose syringe 0.50 mL single-dose vial 5 mL multidose vial

11-Digit NDC Package

preservative free, when administered to children 6-35 months of age, for intramuscular use

90686 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use a

Dosea

CPT Code

HCPCS Code1

49281-0515-25

49281-0515-00 0.25 mL

90685

90685

49281-0415-50

49281-0415-88 0.50 mL

90686

90686

49281-0415-10

49281-0415-58 0.50 mL

90686

90686

49281-0623-15

0.25 mL 49281-0623-78 0.50 mL

90687 90688

90687 90688

Preservative-free CPT Quadrivalent Codes2 90685 Influenza virus vaccine, quadrivalent (IIV4), split virus,

11-Digit NDC Unit

Quadrivalent CPT Codes2,3 90687 Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to children 6-35 months of age, for intramuscular use

90688 Influenza virus vaccine, quadrivalent (IIV4), split virus, when administered to individuals 3 years of age and older, for intramuscular use

Information from 2015 Full Prescribing Information for Fluzone vaccine.

References: 1. CMS. 2012-2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations: Steps to promoting wellness immunizations. http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf. Accessed July 6, 2015. 2. AMA. CPT 2015 Standard Edition (Current Procedural Terminology [Standard]). Chicago, IL: American Medical Association; 2015. 3. AMA. CPT® Category I Vaccine Codes. © 2015 American Medical Association. Last updated July 1, 2015. https://download.ama-assn.org/resources/doc/cpt/x-pub/vaccine-code-desc.pdf. Accessed July 6, 2015.

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CODING FOR FLUZONE VACCINE

Vaccine Fluzone vaccine

Age Indicationa

Presentationa

6 months and older

5 mL multidose vial

11-Digit NDC Package

11-Digit NDC Unit

49281-0396-15

49281-0396-78

Dosea

CPT Code

HCPCS Code1

0.25 mL

90657

90657

0.50 mL

90658

Q2038

Trivalent CPT Codes2,3 90657

90658

Influenza virus vaccine, trivalent (IIV3), split virus, when administered to children 6-35 months of age, for intramuscular use

Influenza virus vaccine, trivalent (IIV3), split virus, when administered to individuals 3 years of age and older, for intramuscular use

Medicare Required HCPCS Code1 Q2038 Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluzone®) a

Information from 2015 Full Prescribing Information for Fluzone vaccine.

References: 1. CMS. 2012-2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations: Steps to promoting wellness immunizations. http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf. Accessed July 6, 2015. 2. AMA. CPT 2015 Standard Edition (Current Procedural Terminology [Standard]). Chicago, IL: American Medical Association; 2015. 3. AMA. CPT® Category I Vaccine Codes. © 2015 American Medical Association. Last updated July 1, 2015. https://download.ama-assn.org/resources/doc/cpt/x-pub/vaccine-code-desc.pdf. Accessed July 6, 2015.

DECISION TREE FOR FLUZONE CODE SELECTION 2015-2016 High Dose?

Yes

Fluzone High-Dose vaccine

90662

Yes

No

Standard Dose? Yes

Fluzone Intradermal Quadrivalent vaccine

Yes

No

Quadrivalent?

Trivalent?

No

Yes

Fluzone Quadrivalent vaccine (Pediatric Dose): Contains no preservative

Yes

Yes

Preservativefree?

Yes

90685 Fluzone vaccine [0.25-mL dose from 5-mL vial]

No Yes

Fluzone Quadrivalent vaccine [0.25-mL dose from 5-mL vial]

Yes

90687

Yes

90688

90686

No

Fluzone Quadrivalent vaccine [0.50-mL dose from 5-mL vial]

90657

90658

No

Yes

Fluzone Quadrivalent vaccine: Contains no preservative

Yes

No

No

Preservative -containing? [multidose vial]

90630

Yes

Fluzone vaccine [0.50-mL dose from 5-mL vial]

Yes

Medicare? Yes

Intradermal?

Q2038

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CODING FOR ADMINISTRATION OF INFLUENZA VACCINE

INFLUENZA VACCINE ADMINISTRATION COMPONENT-BASED CODES

90460 AND 90461

 CPT codes 90460 and 90461 were developed for multicomponent or combination vaccines and are based on the number of vaccine components administered1 – A component is defined as protecting against one disease1  Influenza vaccine contains multiple strains but it is a single-component vaccine, protecting from only influenza virus1  Patients must be 18 years of age or younger and face-to-face counseling must be performed1  Vaccine counseling can include2: – Providing the Centers for Disease Control and Prevention’s (CDC) Vaccine Information Sheet – Discussing the pros and cons of vaccination and patient-specific issues – At-home management of adverse reactions, such as treatment for injection-site reaction – Answering patient and/or parent questions – Documentation that counseling was provided by a qualified health care professional and that the vaccine was administered  Per CPT Guidelines, the professionals qualified to provide face-to-face counseling related to immunization administration are limited to individuals who are qualified by education, training, licensure/regulation, and facility privileging (when applicable), and who perform within their scope of practice and independently report professional services1 References: 1. AAP. Frequently asked questions for the pediatric immunization administration codes. http://www.aap.org/en-us/professional-resources/practicesupport/coding-resources/Pages/FAQ.aspx. Accessed July 6, 2015. 2. AAP. Is the work of vaccine counseling included in the preventive medicine services codes? https://www.aap.org/en-us/professional-resources/practice-support/financing-and-payment/Pages/Is-The-Work-of-Vaccine-Counseling-Included-in-the-Preventive-MedicineServices-Codes.aspx. Accessed July 6, 2015.

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INFLUENZA VACCINE ADMINISTRATION COMPONENT-BASED CODES1 CPT Code Code Type 90460

+90461

90460 AND 90461

Description

Primary per Component

• Immunization administration through18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered

Add-on per Component

• Immunization administration through18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (list separately in addition to code for primary procedure)

• Bill a unit for the first component within the vaccine • Bill 1 unit for influenza vaccine administration

• Bill a unit for each additional component within the vaccine • Not applicable for influenza vaccine

Billed by Component Age Dependent (18 years of age and younger)

Counseling Required

Qualified Health Care Professional

Reference: 1. AAP. Frequently asked questions for the pediatric immunization administration codes. http://www.aap.org/en-us/professional-resources/practice-support/codingresources/Pages/FAQ.aspx. Accessed July 6, 2015.

INFLUENZA VACCINE ADMINISTRATION ROUTE-OF-ADMINISTRATION CODES1

90471 - 90474

 The route-of-administration CPT codes are 90471 through 90474  Used when: – Patients are 19 years of age or older OR – Counseling was not performed, was performed and not documented, or was performed by a health care professional who is not approved to perform counseling per CPT Guidelines  These codes are based on the route of administration, and are not component-based – Coded as one unit for each vaccine administered, no matter how many components in the vaccine

Reference: 1. AAP. Frequently asked questions for the pediatric immunization administration codes. http://www.aap.org/en-us/professional-resources/practice-support/codingresources/Pages/FAQ.aspx. Accessed July 6, 2015.

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INFLUENZA VACCINE ADMINISTRATION ROUTE-OF-ADMINISTRATION CODES1 Injection

90471 - 90474

Intranasal or Oral

CPT Code

Code Type

90471

Primary per Injection

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

+90472

Add-on per Injection

Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid)

CPT Code

Description

90473

+90474

Code Type

Description

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

Add-on Immunization administration by per intranasal or oral route; each Intranasal additional vaccine (single or combination vaccine/toxoid)

Billed by Route of Administration First or Additional Administration?

Reference: 1. AMA. CPT 2015 Standard Edition (Current Procedural Terminology [Standard]). Chicago, IL: American Medical Association; 2015.

INFLUENZA VACCINE ADMINISTRATION VACCINE-SPECIFIC HCPCS CODE1

HCPCS Code G0008

Code Type

Description

Medicare

Administration of influenza virus vaccine

G0008

Required When Billing Medicare for Administration of Any Influenza Vaccine

 Medicare does not recognize the previously discussed component-based or route-of-administration codes if the vaccine is influenza1 – This is true regardless of the patient’s age or which influenza vaccine was administered

Reference: 1. CMS. 2012-2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations: Steps to promoting wellness immunizations. http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf. Accessed July 6, 2015.

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DECISION TREE FOR FLUZONE VACCINE ADMINISTRATION CODE SELECTION1-3 Medicare patient?

Yes

G0008

No Is patient ≤18 years of age?

No

Injectable vaccine?

Yes

Yes

No

Was counseling by qualified HCPa provided? Yes

Yes

No

a

First vaccine today?

90460

90471

+90472

HCP = Health care provider.

References: 1. CMS. 2012-2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations: Steps to promoting wellness immunizations. http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf. Accessed July 6, 2015. 2. AAP. Frequently asked questions for the pediatric immunization administration codes. http://www.aap.org/en-us/professional-resources/practice-support/codingresources/Pages/ FAQ.aspx. Accessed July 6, 2015. 3. AMA. CPT 2015 Standard Edition (Current Procedural Terminology [Standard]). Chicago, IL: American Medical Association; 2015.

OTHER CODING CONSIDERATIONS

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INFLUENZA VACCINE DIAGNOSIS CODES ICD-10a = DOSb October 1, 2015 and After! ICD-10 Code Z23

Description

Suggested Use Primary diagnosis code used for all routine immunizations and immunization administration

Encounter for immunization1

ICD-9c = DOS prior to October 1, 2015 ICD-9 Code

Description

Suggested Use

V04.812,3

Need for prophylactic vaccination and inoculation against certain viral diseases, other viral diseases, influenza4

Primary diagnosis code used for influenza vaccine and its administration

V06.62,3

Need for prophylactic vaccination and inoculation against combination of diseases, Streptococcus pneumoniae (Pneumococcus) and influenza4

Primary diagnosis code used when influenza and pneumococcal vaccines are administered at the same visit

V20.23 or V70.03

Routine infant or child health check Routine general medical examination at a health care facility

Primary diagnosis code used when influenza vaccine and its administration are provided during a preventive visit

Prior to 10/1/15, Medicare requires ICD-9 V04.81 or V06.62

Modifier -SK linked to the vaccine code also identifies a patient as high risk5 a

ICD-10 = International Classification of Diseases, Tenth Revision; b DOS = Date of Service; c ICD-9 = International Classification of Diseases, Ninth Revision.

References: 1. Centers for Disease Control and Prevention (CDC). International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). http://www.cdc.gov/nchs/icd/icd10cm.htm. Accessed July 6, 2015. 2. CMS. 2012-2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations: Steps to promoting wellness immunizations. http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf. Accessed July 6, 2015. 3. AAP. Frequently asked questions for the pediatric immunization administration codes. http://www.aap.org/en-us/professional-resources/practice-support/coding-resources/Pages/FAQ.aspx. Accessed July 6, 2015. 4. Buck CJ. 2014 International Classification of Diseases, 9th Revision, Clinical Modification. Philadelphia, PA; WB Saunders CO; 2013. Clinical Modification 5. Kansas Medical Assistance. Coding Modifiers Table. https://www.kmap-state-ks.us/Documents/Content/Provider/Coding%20Modifiers%20Table.pdf. Accessed July 6, 2015.

ICD-10 VACCINATION CODES EFFECTIVE OCTOBER 1, 2015

ICD-10 Code1

Description

Range of Codes

When to Use

Z23

Encounter for immunization

Z23

Use for routine vaccinations

Z20

Contact with and (suspected) exposure to communicable diseases

Z20.0 – Z20.9

Use when the patient has been exposed to a communicable disease

Z22.0 – Z22.9

Use when the patient is a carrier or suspected carrier of an infectious disease

Z28.0 – Z28.9

Use when the patient is under-immunized, too ill for vaccination, or refuses vaccination

Z22

Z28

Carrier of infectious disease Immunization not carried out and under immunization status

See our Resource section at http://CrackingTheCodesTraining.com/Resources for a list of all vaccination ICD-10 codes

Reference: 1. CDC. International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). http://www.cdc.gov/nchs/icd/icd10cm.htm. Accessed July 6, 2015.

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REPORTING REVENUE CODES FOR INFLUENZA VACCINATION1 Facility Providers Also Add Revenue Codes to Claims

Vaccine Revenue Code

Vaccine Administration Revenue Code

0636

0771

Pharmacy, Drugs Requiring Detailed Coding

Preventive Care Services, Vaccine Administration

Reference: 1. CMS. 2012-2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations: Steps to promoting wellness immunizations. http://www.cms.gov/Medicare/Prevention/Immunizations/Downloads/2012-2013_Flu_Guide.pdf. Accessed July 6, 2015.

REPORTING NATIONAL DRUG CODES (NDC)  Some payers may require you to include the vaccine’s NDC number on the claim  Food and Drug Administration (FDA) guidelines now require all manufacturers to assign different NDCs to a product’s outer carton (unit of sale) and the vial or syringe (unit of use) – Check with your payers to see which NDC they prefer, or if they accept either  The common format for submitting an NDC is a number that, if hyphenated, would appear in a 5-4-2 format. Some drug products are labeled in 4-4-2, 5-3-2, or 5-4-1 formats1  To change these codes to the 11-digit format, a zero is placed within the product code to create the 5-4-2 format1

10-Digit NDC

11-Digit NDC

4444-4444-22

04444-4444-22

55555-333-22

55555-0333-22

55555-4444-1

55555-4444-01

 Keep in mind that this information is not required by all payers1

Reference: 1. American Academy of Family Physicians (AAFP). Coding for vaccine administration http://www.aafp.org/practice-management/payment/coding/admin.html. Accessed July 6, 2015.

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CODING OFFICE VISITS WITH VACCINATION SERVICES  Payers who follow the national Correct Coding Initiative (CCI) effective 1/1/13 require modifier -25 when vaccine administration and a separate and significant E/Ma service are performed at the same visit – Applies to sick and well visits – Modifier -25 is attached to the E/M service – Modifier -25 is not added to the vaccine administration code  The administration code trumps the E/M code – If you bill a vaccine administration code and an E/M code for the same patient on the same date and do not append modifier -25 to the E/M code, Medicare, Medicaid and other payers who follow the CCI edits will only pay for the vaccine administration  CCI will not allow the addition of a modifier to report both 99211 and a vaccine administration

a

E/M = Evaluation and management.

References: 1. CMS. Medicare Claims Processing Manual. Chapter 18–Preventive and Screening Services. (Rev. 2575, 10-26-12.) http://www.cms.gov/Regulations-andGuidance/Guidance/Manuals/downloads/clm104c18.pdf. Accessed July 6, 2015. 2. CMS. 2012-2013 Immunizers’ Question & Answer Guide to Medicare Part B, Medicaid and CHIP coverage of seasonal influenza and pneumococcal vaccinations: Steps to promoting wellness immunizations. http://www.cms.gov/Medicare/Prevention/ Immunizations/Downloads/2012-2013_Flu_Guide.pdf. Accessed July 6, 2015.

CASE STUDIES

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CASE STUDY

FLUZONE QUADRIVALENT VACCINE (PEDIATRIC DOSE): CONTAINS NO PRESERVATIVE  Scenario: A 2-year-old patient with private insurance is seen for a well-child visit and receives Fluzone Quadrivalent vaccine (Pediatric Dose): Contains no preservative. This is the first time the child is immunized against influenza. The physician assistant counsels the child’s parent on the vaccine. A 30-day follow-up appointment is scheduled for the child to receive a second dose of vaccine.1 No qualified counseling or visit is provided when the child receives the second dose. First Dose – DOS 9/15/15 Code

Modifier

99382

25

ICD-9 Code

Description Preventive visit

V20.2

90685

Influenza vaccine, IIV4, preservative-free, 6-35 months of age, IM

V20.2

90460

Vaccine administration, 1st component

V20.2

Second Dose – DOS 10/16/15 Code

ICD-10 Code

Description

90685

Influenza vaccine, IIV4, preservative-free, 6-35 months of age, IM

Z23

90471

Vaccine administration, 1st injection

Z23

Reference: 1. CDC. Prevention and control of seasonal influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2014-2015. MMWR. August 15, 2014/63(32);691-69.

CASE STUDY

FLUZONE INTRADERMAL QUADRIVALENT VACCINE  Scenario: A 50-year-old patient is seen in the physician’s office for management of diabetes. The physician notes the patient is due for Tdapa vaccine and influenza vaccine. The patient is immunized with Tdap vaccine and a 0.5-mL dose of Fluzone Intradermal Quadrivalent vaccine.

a

Code

Modifier

99214

25

Description

ICD-9 Code

ICD-10 Code

Office visit

250.00

E11.9

90715

Tdap vaccine, 7 years of age or older

V06.1

Z23

90471

Vaccine administration, 1st injection

V06.1

Z23

90630

Influenza vaccine, IIV4, preservative-free, intradermal injection

V04.81

Z23

90472

Vaccine administration, additional injection

V04.81

Z23

Tdap = Tetanus, diphtheria, and acellular pertussis.

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CASE STUDY

FLUZONE HIGH-DOSE VACCINE  Scenario 1: A 72-year-old Medicare beneficiary is seen at the physician’s office for chronic obstructive pulmonary disease (COPD) and complains of frequent headaches. The physician takes the opportunity to immunize the patient against influenza using Fluzone High-Dose vaccine. Code

Modifier

99214

25

Description Office visit

ICD-9 Code

ICD-10 Code

496, 784.0

J44.9, G44.1

90662

Influenza vaccine, IIV, increased antigen content, IM

V04.81

Z23

G0008

Administration of influenza vaccine

V04.81

Z23

 Scenario 2: Same as scenario 1 except the patient is seen at a home health visit for COPD and complains of frequent headaches. This time the nurse takes the opportunity to immunize the patient against influenza using Fluzone High-Dose vaccine. All relevant charges for her home health visit are billed. The influenza vaccination is also billed on bill type 34x using codes: Revenue Code

Revenue Code Description

ICD-9 Code

ICD-10 Code

Influenza vaccine, IIV, increased antigen content, IM

0636

Pharmacy, Drugs Requiring Detailed Coding

V04.81

Z23

Administration of influenza vaccine

0771

Preventive Care Services, Vaccine Administration

V04.81

Z23

Code

Description

90662 G0008

CASE STUDY

FLUZONE VACCINE  Scenario 1: A 40-year-old Medicare patient is admitted to the hospital for a knee replacement. During his stay, he is administered trivalent Fluzone vaccine taken from a 5-mL multidose vial. All relevant charges for his stay are billed according to the DRGa system. The influenza vaccination is also billed on bill type 12x using codes: Code

Code Description

Revenue Code

Revenue Code Description

ICD-9 Code

ICD-10 Code

Q2038

Influenza vaccine, IIV3, 3 years of age or older, IM (Fluzone)

0636

Pharmacy, Drugs Requiring Detailed Coding

V04.81

Z23

G0008

Administration of influenza vaccine

0771

Preventive Care Services, Vaccine Administration

V04.81

Z23

 Scenario 2: Same as scenario 1 except the patient is insured by a commercial health plan. Code

a

Code Description

Revenue Code

Revenue Code Description

ICD-9 Code

ICD-10 Code

90658

Influenza vaccine, IIV3, 3 years of age or older, IM

0636

Pharmacy, Drugs Requiring Detailed Coding

V04.81

Z23

90471

Vaccine administration, 1st injection

0771

Preventive Care Services, Vaccine Administration

V04.81

Z23

DRG = Diagnosis related group.

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BE SURE TO VIEW PART 2 AND RESOURCES  Part 2: Medicaid and Medicare Billing for Influenza Vaccination – Medicaid modified billing rules for publicly-supplied and privately-purchased vaccine – Medicaid payment – Medicare billing rules and payment  Downloadable Resources available at http://www.CrackingTheCodesTraining.com/Resources – Coding all influenza vaccines – ICD-10 and vaccines – State-specific Medicaid coding and billing information – Detailed roster billing instructions – Links to resources

QUESTION-AND-ANSWER PERIOD Be sure to also view Part 2 Medicaid and Medicare Billing for Influenza Vaccine

http://www.CrackingTheCodesTraining.com

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THANK YOU FOR PARTICIPATING IN THIS WEBINAR BROUGHT TO YOU AS AN EDUCATIONAL SERVICE BY SANOFI PASTEUR INC.

SANOFI PASTEUR. Discovery Drive. Swiftwater, Pennsylvania 18370. www.sanofipasteur.us 8/15 Printed in USA MKT28461-1R © 2015 Sanofi Pasteur Inc.

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