Influenza Immunization Coding 2017-2018

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Influenza Immunization Coding 2017-2018

Coding tips and news for primary care services

Physicians protect their patients with influenza immunization. Proper coding of influenza vaccines and administration can protect the physician practice against revenue loss related to providing immunizations. It is important to select and report the correct procedure codes for the vaccine product and vaccine administration. 

CMS has also published a MLN Matters (MM10224) detailing the codes for which the Medicare Part B payment allowances apply for dates August 01, 2017-July 31, 2018. The codes for which the Medicare Part B payment allowances apply and which are not noted as subject to medical necessity determination are 90653, 90655, 90656, 90657, 90661, 90685, 90686, 90687, 90688, Q2035, Q2036, Q2037, and Q2038. If you are providing influenza vaccines products described by codes 90630, 90654, 90662, 90672, 90672, 90674, 90682, 90756 and Q2029; payment is subject to the Medicare Administrative Contractor’s (MAC’s) determination that use of the vaccine is reasonable and necessary for the beneficiary. Be sure to check the information provided from the MAC in your region for any policy on the vaccines that are subject to a reasonable and necessary determination before administering. (I did a brief search and did not find any MAC that was excluding these vaccines. If you have a resource from a MAC that indicates limited coverage, please share in the comment section 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 examination (codes in category Z00).

The administration of immunizations is reported in addition the vaccine product code. Be sure to use code G0008 for reporting influenza vaccine administration to Medicare Part B. For most other payers, administration of influenza vaccine is reported with codes 90460 (patient under age 19 and physician or qualified health care professional provided counseling regarding influenza immunization) or 90471-90472 (report 90471 for first or only vaccine administered, 90472 when administered subsequent to another vaccine on the same date).

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