Influenza Vaccine Coding for Urgent Care

When your urgent care center gets its supply of influenza vaccine for the 2006-2007 flu season, you will need to accurately code the:

• diagnosis code,
• administration code, and
• supply code.

This can be quite a challenge, so the coders a Practice Velocity have put together a guide to help you with coding your flu vaccine visits this year.

Diagnosis (ICD-9) Code:
V04.81: "Prophylactic vaccination and inoculation against influenza."

Administration Code (CPT* or HCPCS)
For each administration of the influenza vaccine, the coder should code an administration code.

HCPCS: Medicare (and some third party payers):

• G0008: require Healthcare Common Procedure Coding System (HCPCS) code G0008 to report administration of influenza vaccine.

CPT: Many Third Party Payors require:

• 90471:"Immunization administration (includes. . . intramuscular injections); one vaccine (single or combination vaccine/toxoid)"

90472: Use one code each for additional intramuscular injections of vaccine/toxoid on the same date.

• 90473: "Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)"

99474: Use one code each for additional intranasal or oral administrations of vaccine/toxoid on the same date.

Note: Urgent care providers should review the policy for each individual third-party payor in order to avoid unnecessary appeals and to ensure timely reimbursement.

Supply Codes (CPT*) for influenza vaccines

For the 2006-2007 influenza immunization season, the National Drug Code (NDC) numbers and product descriptions are:

CPT* Code	CPT Description	Manufacturer, Brand	NDC number		Supplied as
90655	Influenza virus vaccine, split virus, no preservative, for children 6-35 months of age, for intramuscular use	Fluzone, Aventis Pasteur no preservative	49281-006-25		10 single-dose (0.25ml) syringes
90656	Influenza virus vaccine, split virus, no preservative, for use in individuals 3 years of age and above, for intramuscular use	Fluzone, Aventis Pasteur no preservative	49281-006-50	10 single-dose (0.5ml) syringes
			49281-006-10	10 single-dose (0.5ml) vials
		Fluarix, Influenza Virus Vaccine, no preservative	58160-873-46		10 single-dose (0.5ml) vials
		Fluvirin, Chiron Vaccines, no preservative	66521-109-01		10 single-dose (0.5ml)syringes
90657	Influenza virus vaccine, split virus, for children 6-35 months of age, for intramuscular use	Fluzone, Aventis Pasteur	49281-378-15		5 ml multi-dose vial
90658	Influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use	Fluzone, Aventis Pasteur	49281-006-15		5 ml multi-dose vial
		Fluvirin, Chiron Vaccines	66521-109-10		5 ml multidose vial
		Flulaval, GlaxoSmithKline	19515-883-07		5 ml multidose vial
90660	Influenza virus vaccine, live, for intranasal use	FluMist, MedImmune Vaccines, Inc	66019-104-01		10 prefilled, single-use sprayers

Note: This information is for coding educational purposes only and should not be used as a clinical guide or as a guide for any specific coding scenario. The user of this information specifically releases Practice Velocity, LLC from any liability or potential liability that might arise as a direct or indirect consequence from reading the information contained on this website.

Some of this information may be expanded from the Coding Q&A column by David Stern, MD, CPC (CEO, Practice Velocity, LLC) published monthly in the Journal of Urgent Care Medicine. Physicians may click on the JUCM icon to the left to order a FREE SUBSCRIPTION to the Journal.

Practice Velocity Urgent Care Solutions is the leading provider of software for charting, coding and billing in urgent care centers in the USA. Click here to request information about Practice Velocity's automated charting and coding solutions for urgent care.

 

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