Health Information Management

Q&A: Should we wait to bill flu vaccine?

APCs Insider, September 13, 2013

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Q: We have started administering the flu vaccine using Fluzone, but the CPT® code has a status indicator of E (items or services not covered under OPPS) and our claims are being rejected. Do we have to wait until January to bill for this when CMS updates APC rates?

A: Fortunately, you can report the service now. The FDA approved CPT code 90685 (influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use) June 7 and CMS is changing the status indicator. Beginning with the July OPPS update, the status indicator for this code is being changed to L (influenza vaccine; pneumococcal pneumonia vaccine) and can be billed for dates of service beginning June 7, 2013.

CMS announced this update in Transmittal 2775.

 

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.



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