Shade Posted Tue 30th of December, 2014 09:39:24 AM
please help with this question as from 2015 our facility will be given shingles and the new pneumonia vaccines, do you know if medicare is paying for it and if yes what is the appropriate code to use. your respond is needed asap please. thank you.
SuperCoder Answered Tue 30th of December, 2014 10:11:24 AM
There are three codes for pneumonia vaccination:
90669, Pneumococcal conjugate vaccine, 7 valent, for intramuscular use.
90670, Pneumococcal conjugate vaccine, 13 valent, for intramuscular use.
90732, Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use.
The code you report for the administration of the vaccine depends on the insurer. For the administration of the pneumonia vaccine to a Medicare beneficiary, use G0009 (Administration of pneumococcal vaccine when no physician fee schedule service on the same day).
For those insurers that do not follow Medicare guidelines, use 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]).
Medicare covers pneumonia vaccine once in a lifetime and my consider additional vaccine based on risk.
For shingle vaccine use code:
90736, Zoster (shingles) vaccine, live, for subcutaneous injection. Use code 90471 for administration.
Shingle vaccine is not covered under Medicare part B. It is included as benefit under Medicare part D.
Shade Posted Tue 30th of December, 2014 10:30:07 AM
thank you for your quick response. what is the dx. code to use with the pneumoccoccal and shingle vaccine. quick response will be appreciated. thank you.
Shade Posted Tue 30th of December, 2014 10:42:39 AM
please can this code be use for the new pneumonia vaccine. and my question is will medicare pay for the new pneumonia that just come out for adult above 50yrs. please reply asap. thank you.
SuperCoder Answered Tue 06th of January, 2015 07:48:28 AM
There is no specific information available for this new vaccine. Medicare covers all pneumonia vaccine once in a life time. It may cover additional vaccine based on the risk.
For pneumonia vaccination, you should use the Dx V03.82, Need for prophylactic vaccination and inoculation against streptococcus pneumoniae [pneumococcus].
For shingle vaccine, you should use the Dx V04.89, Need for prophylactic vaccination and inoculation against other viral diseases.