Hot Coding Topics

Flu Vaccines: Replace 90658 by new Q codes

Your vaccine coding in 2011 will be anything but dull, thanks to changes in codes and administration reporting. Two more updates every FP should know involve new Q codes for some Medicare flu vaccines and expanded ages for adolescent vaccine counseling.

Nix 90658 in 2011

CMS has created new HCPCS codes and payment allowances to replace 90658 (Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use). Medicare will no longer pay for 90658 effective Jan. 1, 2011, so choose from the new codes instead, based on the specific product:

  • Q2035 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)
  • Q2036 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)
  • Q2037 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)
  • Q2038 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)
  • Q2039 — Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (not otherwise specified).

Timing: Codes Q2035-Q2039 went into effect Oct. 1, 2010. You have two choices when filing claims for dates of service from Oct. 1, 2010 until Dec. 31, 2010: bill Medicare immediately with 90658, or hold the claim until Jan. 1, 2011 and file with the appropriate Q code. For vaccines administered after Jan. 1, 2011, only report the applicable Q code.

Explanation: Medicare pays for influenza vaccine based on 95 percent of the average wholesale price. “The products normally classifiable to 90658 have widely varying AWPs,” says Kent J. Moore, manager of...

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December 15, 2010
CCI / NCCI / Provider News

Avoid Denials With This Lowdown on Newborn CCI Bundles

These edits took effect April 1, so start observing them yesterday.

The latest version of the Correct Coding Initiative (CCI) has an edit that family practice coders should note – especially if the practice treats newborn patients.

Get to know the new CCI 16.1 edit and get ready to observe it with this expert breakdown. Check Column 1 on These Hospital E/Ms According to CCI 16.1, these codes are in column 1 of the mutually exclusive edits:

  • 99231 (Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a problem focused interval history; a problem focused examination; medical decision making that is straightforward or of low complexity …)
  • 99232 (… an expanded problem focused interval history; an expanded problem focused examination; medical decision making of moderate complexity …)
  • 99233 (… a detailed interval history; a detailed examination; medical decision making of high complexity …).

Column 2 of these edits includes these codes:

  • 99460 (Initial hospital or birthing center care, per day,for evaluation and management of normal newborn infant)
  • 99461 (Initial care, per day, for evaluation and management of normal newborn infant seen in other than hospital or birthing center)
  • 99462 (Subsequent hospital care, per day. for evaluation and management of normal newborn).

Translation: An FP may not report both normal newborn care and subsequent hospital care for a newborn on the same date of service. If the FP performs normal newborn services (99460-99462) on the same date that the newborn later becomes ill and receives subsequent hospital care (99231-99233), you should only report a code from the 99231-99233 code set, explains Kent Moore, manager of health care financing and delivery systems for the American Academy of Family Physicians (AAFP) in Leawood, Kan.

The...

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May 20, 2010