Medical Billing: Flu Season Approaches!

The kids are back in school, the days are becoming just a little bit shorter and maybe a slight cooler. You may be seeing pumpkins and Halloween candy in your local market.

fall flu season

It’s obvious, fall is approaching, and with it…. cold and flu season, UGH! flu virus

Things to know about flu (and colds):

Colds and flu share many symptoms, but fever, body aches, extreme tiredness, and dry cough are more common and intense in cases of the flu. Whereas, colds tend to produce a runny or stuffy nose.

Tests during the first days of illness can detect influenza and may be indicated for those considered high risk to flu complications.

Seniors and people with chronic health conditions—like asthma, diabetes, and heart disease—are at a higher risk for serious complications from the flu.

Based on research predictions, the upcoming season's flu vaccine will protect against these three influenza viruses: an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

Even though the timing and duration of flu seasons can vary, for those living in the US, winter is the time typical time with some outbreaks as early as October. Most of the time flu activity peaks in January or later.

You can be contagious 1 day before any flu symptoms occur and you may be able to pass on the flu to someone else up to 5 to 7 days after becoming sick.

It will take approximately two weeks after vaccination for your body to develop the antibodies to protect against influenza virus infection.

Everyone 6 months and older should get a flu vaccine each year.

Flu and Pneumonia Stats:

According to the Centers for Disease Control and Prevention:

In a 30-year study period, from 1982-2012, flu activity most often peaked in February (14 seasons, or 47% of the time).

In a 30-year period, from 1976-2006, annual flu-associated death estimates ranged from a low of about 3,000 to a high of about 49,000 in the US.

The 2012 season deaths related to flu and pneumonia were the highest in nearly a decade, and people 65 years and older accounted for half of all flu-related hospitalizations.

So let’s refresh our memories on the coding and reimbursement guidelines for Influenza Virus and Pneumococcal vaccinations.

denial

If you are not submitting the correct diagnosis and procedure codes you will not receive the proper claim reimbursement.

The vaccine procedure code should be chosen based on the description of the drug and the age of the patient.

Each vaccine code should be billed with the appropriate administration code as well.

The following procedure and diagnosis codes are used for influenza virus vaccinations:

CPT/HCPCS Code	Description
90654	Influenza virus vaccine, split virus, preservative free, for intradermal use
90655	Influenza virus vaccine, split virus, preservative free, for children 6-25 months of age, for intramuscular use
90656	Influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use
90657	Influenza virus vaccine, split virus, for children 6-25 months of age, for intramuscular use
90660	Influenza vaccine, live, for intranasal use
90662	Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use. (High Dose)
Q2034	Influenza virus vaccine, split virus, for intramuscular use (Agriflu)
Q2035	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Afluria)
Q2036	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluluval)
Q2037	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluvirin)
Q2038	Influenza virus vaccine, split virus, when administered to individuals 3 years of age and above, for intramuscular use (Fluzone)
G0008	Administration of influenza virus vaccine

Diagnosis Code	Description
V04.81	Influenza vaccination with dates of service 10/1/2003 and later
V06.6	Influenza and pneumococcal vaccination (Report this code when the purpose of the visit was to receive both vaccinations during the same visit)

The following procedure and diagnosis codes are used for pneumococcal vaccinations:

CPT/HCPCS Code	Description
90669	Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use
90670	Pneumococcal conjugate vaccine, 13-valent, for intramuscular use
90732	Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use
G0009	Administration of the pneumococcal vaccine when no physician fee schedule service on the same day

Diagnosis Code	Description
V03.82	Pneumococcal vaccination
V06.6	Pneumococcal and influenza vaccination (Report this code when the purpose of the visit was to receive both vaccinations during the same visit)

Coding Hint: Based on CCI edits, when performing an unrelated E/M service on the same date as the vaccination, append a “25” modifier to your E/M service procedure code to prevent denials of your immunizations.