Among the Centers for Medicare and Medicaid Services’ new codes is one that’s likely to be confusing as patients start coming in for flu shots. A quadrivalent vaccine made and distributed by Sequirus is available for reporting, but if billing staff use the corresponding code, 90756 (Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use) before January 1, 2018, the claim will be denied. Instead, they’re advised to use current HCPCS code Q2039 (Influenza virus vaccine, not otherwise specified). At least some private payers are expected to follow CMS’s lead, so communicating with them—and your coding vendor—until then would be wise. (David Stern, MD, chief executive officer of Practice Velocity, NMN Consultants, and PV Billing will offer a preview of urgent care-relevant changes in ICD-10-CM codes in his Revenue Cycle Management Q&A column in the September issue of JUCM.)

Be Mindful of Dates of Service When Coding for Flu Shots—or Get Claims Denied

David Stern, MD

Chief Executive Officer at Practice Velocity Urgent Care Solutions, Founding Member of the Urgent Care Association of America, Publishing Staff for The Journal of Urgent Care Medicine
Share this !