4 Coding & Billing Steps Boost Your Flu Prevention Pay by $38

Posted on 09. Sep, 2009 by Editor in Hot Coding Topics

Do you know how old the patient is? If you don’t, here’s how you’re losing reimbursement.

A pediatric practice recently asked Pediatric Coding Alert for money-making tips as staff gear up for flu season. “In the past, we have had difficulty in just breaking even for the cost of the influenza vaccine,” wrote the subscriber. “How can we be reimbursed by private insurances at the best rate of return?” she asked.

Here’s how to clear several coding pitfalls that can sink flu vaccination payments. “Make sure you code correct route, correct product, correct ICD-9,” says Cathy Gray, RHIT, CCS, CPC-I, CCC, CGIC, with Henry Ford Health System in Detroit.

1: Avoid Losing $10 by Checking Preservative-Free

Look at the manufacturer’s box to verify that you’re reporting the correct product code for the influenza product the patient is receiving. Preservative-free products, including Fluzone No Preservative, Fluvirin Preservative-Free, and Fluarix, cost more and should reimburse at a higher rate than non-preservative-free products (Fluzone and Fluvirin). Intranasal product FluMist (90660, Influenza virus vaccine, live, for intranasal use) pays the most ($22.316 using 2008 rates).

Don’t miss the Pediatric Specialty Coding & Billing Conference in Orlando this December. Click here to see the great sessions planned with Donelle Holle, Jennifer Godreau, Dr. Richard Tuck & more.

Example: If a patient received Fluzone No Preservative Pediatric and you incorrectly used the regular product code (90657, Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use), rather than the preservative-free product code (90655, Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use), you would lose $10 in reimbursement. The payment allowance for the preservative-free pediatric product code (90655) is $16.879 compared to $6.609...

Tags: 90474, 90648, 90655, 90657, 90658, 90660, flu, Fluarix, Fluvirin, Fluzone, influenza, pediatric, preservative, vaccine