Flu Vaccine Coding – How to Code for Influenza Vaccine

Hello everyone and welcome to our podcast series. I’m Natalie Tornese, one of the senior solutions managers at Outsource Strategies International. Let’s talk about the flu.

The flu season is in full swing and the latest Centers for Disease Control and Prevention (CDC) report is that flu activity continues to rise. Immunization is the most effective way to prevent influenza illness and its complications. There have been a couple of changes that providers need to be aware of when billing and coding for flu vaccine.

The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Traditional flu vaccines called trivalent vaccines are made to protect against three flu viruses: two influenza A viruses (H1N1) and (H3N2), and an influenza B virus. There are also flu vaccines made to protect against four flu viruses called quadrivalent vaccines. These vaccines protect against the same viruses as the trivalent vaccine, with the addition of another B virus.

The CDC recommends injectable influenza vaccines (including inactivated influenza vaccines and recombinant influenza vaccines) during the 2017-2018 season. Both trivalent (three-component) and quadrivalent (four-component) flu vaccines will be available.

Trivalent flu vaccines include the following:

• Standard-dose trivalent shots (IIV3) that are manufactured using virus grown in eggs. Different flu shots are approved for different age groups. Most flu shots are given in the arm muscle with a needle. One trivalent vaccine formulation can be given with a jet injector for persons aged 18 through 64.
• A high-dose trivalent shot is approved for people 65 and older.
• A recombinant trivalent shot that is egg-free is approved for people 18 years and older, including pregnant women.
• A trivalent flu shot made with adjuvant, an ingredient of a vaccine that helps create a stronger immune response in the patient’s body. This is approved for people 65 years of age and older and is new this season.
• Quadrivalent flu shots approved for use in different age groups as well, including children as young as 6 months.
•  An intradermal quadrivalent flu shot, which is injected into the skin instead of the muscle and uses a much smaller needle than the regular flu shot. It is approved for people 18 through 64 years of age.
• A quadrivalent flu shot containing a virus grown in cell culture, which is approved for people 4 years of age and older.

Those are the different types of flu shots. Well, what’s new this flu season?

• Well, the recommendation not to use the nasal spray flu vaccine (LAIV) was renewed for the 2017-2018 season. Only injectable flu shots are recommended for use again this season. 
• Pregnant women may receive any licensed, recommended, and age-appropriate flu vaccine.  However, there is some concern about administration of the flu shot during the first trimester.
• Two new quadrivalent (four-component) flu vaccines have been licensed: one inactivated influenza vaccine (“AfluriaQuadrivalent” IIV) and one recombinant influenza vaccine (“Flublok Quadrivalent” RIV).
• The age recommendation for “FlulavalQuadrivalent” has been changed from 3 years old and older, to 6 months and older to be consistent with FDA-approved labeling.
• The trivalent formulation of Afluria is recommended for people 5 years and older, which changed (from 9 years and older) in order to match the FDA administration package insert.
• CMS released a quarterly vaccine code update in January of 2018 regarding the new influenza vaccine code 90756. This new influenza virus vaccine code has been implemented for DOS (date of service) on or after January 1, 2018.

Code 90756 is an influenza virus vaccine, quadrivalent, derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use.

Keep in mind that this code is not retroactive. Claims will not be accepted that contain the influenza virus vaccine code 90756 between the DOS of August 1, 2017, and December 31, 2017. If these claims are received in January of 2018 containing this code 90756, they will be rejected or returned as un-processable.  It is in these cases that MACS would use the existing Q2039 code.

For more information, you can review the MLN matters MM10196-revised 

The Medicare Annual Part B deductible and coinsurance amounts do not apply for these vaccinations. All physicians, practitioners, and suppliers who administer these vaccines must take assignment on the claim for the vaccine.

The administration of immunizations is reported in addition to the vaccine product code. Don’t forget your administration codes. Be sure to use code G0008 for reporting the influenza vaccine administration. This is for Medicare patients. For most other payers, when you are billing for the administration of the vaccine, you would report codes 90460 (that’s for patients under 18  with counseling regarding the influenza immunization). Or, you can use 90471-90472. You use 90471 for the first or only vaccine administered, and 90472 when administered subsequent to another vaccine on the same date.

Being that there are so many CPT codes for the influenza vaccine, accurate coding is critical. Coding is based on the product you are using.  Please review the transcript for a link to the CPT as well as the administration codes 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 exam.

Remember that for ICD 10 diagnostic codes, additional codes should be used, if applicable, to identify any manifestations or associated conditions.  I can say a thousand times, please remember to only assign what the clinicians document. A list of all influenza and associated ICD 10 codes can be found in the transcript below as well.

 I hope this helps, but always remember that documentation as well as a thorough knowledge of payer regulations and guidelines is critical to ensure accurate reimbursement for the procedures performed.

Thank you for listening.