Track Payer’s Preferred H1N1 Admin Code — or Risk Rejections

Posted on 03. Nov, 2009 by sanjay.aikat in Hot Coding Topics

Code 488.1 does not = confirmed lab.

Swine flu has made an early arrival in several states and in your 2009 preventive and sick coding. To avoid denials for H1N1 vaccination administration, you’re going to have to check which of three administration code options your major payers want. “Some payers want you to use the new code, others want you to use Medicare’s code, and others want you to use the regular vaccine administration codes,” says Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville.

Best bet: Create an Excel spreadsheet that lists which H1N1 vaccine administration code each of your payers requires. Here are the options.

Use AMA-Preferred 90470 as New CPT 2009 Code

The AMA fast-tracked a CPT code for vaccine administration specifically for H1N1, Tuck says. Code 90470 (H1N1 immunization administration [intramuscular] [intranasal] including counseling when performed]) is effective immediately.

In addition, CPT revised the existing product code from a generic pandemic code to specify H1N1. Revised code 90663 will now read “Influenza virus vaccine, pandemic formulation, H1N1.” The revision adds “H1N1” to the descriptor shown in your CPT 2009 manual.

“The new CPT code will streamline reporting and the reimbursement procedure for physicians and health care providers who are expected to administer nearly 200 million doses of the H1N1 vaccine in the United States,” announced the AMA in “CPT Codes for 2009 H1N1 Influenza Immunizations.” “The codes will also help to efficiently report and track immunization and counseling services related to the H1N1 vaccine throughout the health care system.”

Report G9141 to More Than Medicare Carriers

To muddy the waters, Medicare had already created G9141 (Influenza A [H1N1] immunization administration [includes the physician counseling the patient/family]).“Medicare had established the precedent for a specific code for...

Tags: 488.1, 90470, G9141, H1N1, swine