Saturday, October 24, 2009

Interesting Week... H1N1 at the forefront of the news.....

This has really been an interesting week... with H1N1 being at the forefront of the news, I am sure you have had coding issues come up surrounding it!

According to "Beckers Hospital Review"

The American Medical Association has expedited the publication of a new code specific to vaccine administration and revised existing code 90663 to include the H1N1 vaccine, according to an AMA news release.
The new codes will streamline the reporting and reimbursement procedure for physicians and healthcare providers administering the vaccinations and help to report and track immunization and counseling services related to the H1N1 vaccine throughout the healthcare system, according to the release.

Codes were created in consultation with the Department of Health and Human Services. Code 90470 was created to report H1N1 immunization administration and counseling. Code 90663 was revised by the CPT Editorial Panel to refer specifically to the H1N1 vaccine product. Both codes are effective immediately.

For reference, the two CPT codes are:

* 90470-H1N1 immunization administration (intramuscular, intranasal), including counseling when performed

* 90663-Influenza virus vaccine, pandemic formulation, H1N1

Your ICD-9 Driver should be codes

* 487.0 Influenza w/pneumonia
* 487.1 Influenza w/other respiratory manifestations
* 487.8 Influenza with other manifestations

* 488.0 Influenza due to identified avian influenza virus
* 488.1 Influenza due to identified novel H1N1 influenza virus

* V04.81 Influenza (Need for prophylactic vaccination/innoculation)
* V04.89 Other Viral Diseases (Need for prophylactic vaccination/innoculation)

Keep in mind too, that if you are giving additional vaccinations at the same time, you will need to review the criteria in your CPT books.

Stay Healthy and next week I'll post the Audit criteria for Medical Decision Making!


  1. there are also new HCPCS codes, G9141 and G9142, for H1N1 vaccine and administration. Per CMS, they are effective 9/1/09. Medicare would not pay for the vaccine, since the vaccine H1N1 will be available at no cost, but they would pay for the administration of the vaccine.
    According to SE0920, payment for G9141 will be paid at the same rate established for G0008 (Administration of influenza virus vaccine). can you provide some guidance as to when to use the CPT codes and when to use the HCPCS codes? Thanks!

  2. hmm Such a nice post and very informative. i got useful info from this post... keep it up and Thanks for sharing.

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