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Flu Shots (RHFMC)

Chuck Posted Thu 13th of February, 2014 15:43:15 PM

Could you please look at the codes below that I use for flu shots? Please let me know your thoughts. Thank you!
Chuck
Flu Vaccine Code Administration
Commercial (BC/BS, etc.) 90658 90471
Medicare Q2038 G0008
Medicaid (age 17 & under) 90658 90471
Medicaid (age 18 & over) Q2038 90471

SuperCoder Answered Fri 14th of February, 2014 11:53:12 AM

The commercial and Medicare codes may be correct depending on the circumstances. You should check the various codes available to see whether a more appropriate one applies. For instance, review the list of codes from 90655 on to see the various vaccine options. Factors include trivalent vs. quadrivalent, patient age, and whether the vaccine is preservative free. Also look at the options for admin with counseling, such as 90460.

For Medicare, this document helps demonstrate the various options that pair with G0008: https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/qr_immun_bill.pdf

Medicaid rules vary state to state, so you’d need to check the specific one. E.g., see PDF page 1375 of this Texas Medicaid document. http://www.tmhp.com/TMHP_File_Library/Provider_Manuals/TMPPM/2013/September2013_TMPPM.pdf

Chuck Posted Tue 18th of February, 2014 10:32:28 AM

Thank you!
I'll do some research based on your suggestions!

SuperCoder Answered Wed 19th of February, 2014 18:59:41 PM

You are always welcome!

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