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Select a HCPCS code when reporting common vaccine administrations

Double check the administration code you’re reporting for vaccines and injections that you deliver frequently and think twice about choosing a common CPT code that is tied to a large number of denials for Medicare’s covered services.

Ultimately, Medicare discourages the use of CPT code 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) for commonly administered vaccines, says Betsy Nicoletti, president of Medical Practice Consulting in Northampton, Mass.

“They want you to use a HCPCS code,” says Nicoletti about Medicare’s preferred reporting method. Yet many practices seem to be stuck in the misguided routine of using 90471 alongside the vaccine code for three vaccines — flu, pneumococcal and hepatitis B.

That’s simply incorrect coding — and you won’t get paid for your efforts, says Nicoletti. Many practices succumb to incorrect usage of 90471, as denial rates exceed 73% on the more than 971,000 claims filed in 2014, the latest year of available claims data. Ultimately, that’s $28.4 million in denied claims.

Some of those denials may be associated with vaccines that Medicare simply doesn’t cover, such as tetanus in a non-emergent situation, notes Nicoletti. However, many practices are likely losing money because of inaccurate reporting on services that Medicare does cover.

Give your vaccine coding a shot in the arm

You have about 20 distinct flu vaccine codes to choose from in a given year. Yet Medicare accepts just one administration code — G0008 (Administration of influenza vaccine), according to the Medicare Part B Immunization Billing guide from CMS.

The same holds true for the pneumococcal vaccine (90670, 90732) and hepatitis B vaccine (9073990747). They each take their own administration code — G0009 (Administration of pneumococcal vaccine) and G0010 (Administration of hepatitis b vaccine), respectively.

3 more tips for correct vaccine coding

Report both administration codes when you deliver the flu and pneumococcal vaccines to the same patient on the same date of services. “Medicare pays both administration fees,” states the billing guide. In this case, report both G0008 and G0009 on your claim.

Attach ICD-10 diagnosis code Z23 (Encounter for immunization) every time you bill a flu, pneumococcal or hepatitis B vaccine in addition to the administration and vaccine codes.

Save the 90471 administration code for emergent situations, advises Nicoletti. For instance, you can bill a tetanus vaccine when the patient presents with an injury, she notes. In that case, report the correct tetanus code (90715) along with the 90471 administration code.

Resources:
Medicare Part B Immunization Billing