Revised coding for flu vaccinations may complicate immunization process

The A(H1N1) pandemic is past. That influenza strain was included in this year's seasonal vaccine, supplies of which have been plentiful. But one factor may complicate the immunization process for physicians offices this season: impending changes to vaccination coding.

"Medical practices have to stay current," said Peggy Stilley, director of audit services for AAPC Physician Services. "They have to know what is changing and how it is changing." (See correction)

As of Jan. 1, 2011, medical practices need to use the Healthcare Common Procedure Coding System's "Q" codes for the vaccines provided to Medicare beneficiaries instead of the Current Procedural Terminology code of 90658.

"Q" codes differ according to the version of the vaccine used. They are:

• Q2035 for Afluria.
• Q2036 for FluLaval.
• Q2037 for Fluvirin.
• Q2038 for Fluzone.
• Q2039 for any other flu vaccine not specified.

The HCPCS code of G0008 continues to apply to the administration of this immunization.

Though some insurers will want the HCPCS codes for vaccine administration, others will require CPT coding, some of which will change at the beginning of the year. Codes 90460 and 90461 are to be used to report immunization administration services to people under 18, but 90471, 90472, 90473 and 90474 can continue to be used for people who are older or when physician counseling is not provided. How these apply depends on the age of the patient, the type of vaccine used and what other immunizations are given at the same time.

The code 90662 was added for the high-dose version of Fluzone, since it is now available for people 65 and older. Codes for intramuscular versions of vaccines -- 90655, 90656, 90657 and 90658 -- remain the same, as does 90660 for the FluMist intranasal vaccine.

The codes for the H1N1 influenza vaccine, 90663, and its administration, 90470, should not be used this season. All doses have expired and should be discarded.

"Just forget about H1N1 for now," said Cindy Hughes, a coding and compliance specialist at the American Academy of Family Physicians. "For those who are coding, it doesn't make any difference."

The ICD-9 code for administering the vaccine -- V04.81 -- remains unchanged for all patients. When pneumococcal and influenza vaccines are administered together, the ICD-9 code is V06.6 -- "need for prophylactic vaccination and inoculation against streptococcus pneumoniae and influenza."