Medical Billing and Coding for Flu

Vaccine Administration
Providers should keep tabs on the available
flu vaccines and also ensure accurate
documentation through proper vaccination
coding.

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With the new flu season (October to May) drawing near, providers are gearing
up for timely vaccine administration for their patients. The Centers for Disease Control
and Prevention (CDC) recommends flu vaccine administration as the crucial step to
achieve immunity from this epidemic. It is very important to get vaccinated as soon as
the vaccine becomes available, if possible by October. Healthcare providers should now
keep tabs on the available vaccines and also pay attention to correct medical billing and
coding for vaccinations.

Vaccines can change during each flu season according to the particular influenza strains
the CDC and other public health officials expect that season. Flu and vaccination coding
depends on those vaccines. As per the CDC, both trivalent and quadrivalent influenza
vaccine will be available this season with different routes of administration including
intramuscular, intradermal, jet injector and nasal spray. To be more specific, this season:

Intramuscular vaccines will be available in trivalent and quadrivalent

formulations while high dose vaccines will be trivalent.

For people in the age group 18 to 64, a jet injector can be used for delivery of
one particular trivalent flu vaccine (AFLURIA by bioCSL Inc.)

Nasal spray vaccines and intradermal vaccine will all be quadrivalent.

Flu Vaccine Documentation and Coding

Providers should document the following vaccine information on patients charts in

order to choose the correct influenza vaccine codes.

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Patients age

Specify whether the vaccine is active or inactivated, recombinant or live

attenuated

Specify whether vaccine is trivalent (abbreviated IIV3, for inactive influenza

vaccine, trivalent) or quadrivalent (abbreviated IIV4, for inactive influenza
vaccine, quadrivalent)

Preservative status of the vaccine (presence of thimerosol and mercury content)

Dosage and route of administration

Different types of vaccine codes effective from January 2015 are as follows:

90630: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free,
for intradermal use, ages 18-64 only

90654: Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for
intradermal use, ages 18-64 only

90655: Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for
children 6-35 months of age, for intramuscular use

90656: Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, for
use in individuals 3 years and above, for intramuscular use

90657: Influenza virus vaccine, trivalent (IIV3), split virus, for children 6-35
months of age, for intramuscular use

90658: Influenza virus vaccine, trivalent (IIV3), split virus, for use in individuals 3
years of age and above, for intramuscular use

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90660: Influenza virus vaccine, trivalent (LAIV3), live, for intranasal use, ages 249 years only

90661: Influenza virus vaccine (ccIIV3), derived from cell cultures, subunit,
preservative and antibiotic free, for intramuscular use, ages 18-99 only

90662: Influenza virus vaccine (IIV), split virus, preservative free, enhanced
immunogenicity via increased antigen content, for intramuscular use, ages 65
and older only

90672: Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use, ages
2-49 only

90673: Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA
(RIV3), hemagglutinin (HA) protein only, preservative and antibiotic free, for
intramuscular use, ages 18-49 only

90685: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free,
when administered to children 6-35 months of age, for intramuscular use, ages
6-35 months only

90686: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free,
when administered to individuals 3 years of age and older, for intramuscular use,
ages 3-99 years only

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

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90688: Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free,
when administered to individuals 3 years of age and older, for intramuscular use,
ages 3-99 years only

Q2034: Agriflu influenza virus vaccine, split virus, for intramuscular use, ages 1899 years only

Q2035: Afluria influenza virus vaccine, split virus, for use in individuals 3 years of
age and above, for intramuscular use

Q2036: Flulaval influenza virus vaccine, split virus, for use in individuals 3 years
of age and above, for intramuscular use

Q2037: Fluvirin influenza virus vaccine, split virus, for use in individuals 3 years of
age and above, for intramuscular use

Q2038: Fluzone influenza virus vaccine, split virus, for use in individuals 3 years
of age and older, for intramuscular use

Q2039: Influenza virus vaccine, split virus, when administered to individuals 3

years of age and older, for intramuscular use (not otherwise specified)

New Category I Vaccination Codes

The American Medical Association (AMA) recently published a list of 2016 CPT Category
I Vaccine codes, which includes a number of new vaccination codes.

90620: Meningococcal recombinant protein and outer membrane vesicle vaccine,

Serogroup B, 2 dose schedule, for intramuscular use (FDA approved)

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90621: Meningococcal recombinant lipoprotein vaccine, Serogroup B, 2 or 3

dose schedule, for intramuscular use (FDA approved)

90651: Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58,
nonavalent (HPV), 3 dose schedule, for intramuscular use (FDA approved)

90697: Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated

poliovirus vaccine, Haemophilus influenza type b PRP-OMP conjugate vaccine,
and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use (awaiting
FDA approval)

Vaccine Administration Codes

You should report the appropriate vaccine administration codes from the following
series, apart from the vaccine code.

90471: Immunization Administration, one injection (Do not report with 90460 or
90473)

+90472: Immunization Administration, each additional injection

90473: Immunization Administration by intranasal/oral route; one vaccine (Do

not report with 90460 or 90471)

+90474: Immunization Administration by intranasal/oral route; each additional

vaccine

Keep up to date with the coding guidelines specified by different healthcare plans also
to ensure effective medical coding. Providers can save the effort and time involved in

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streamlining the medical billing process with efficient external support from a reliable
billing firm. Experienced medical billing and coding companies continue to support
healthcare entities providing value-added service with their AAPC-certified medical
coders.

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