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...