Health Information Management

Q/A: Reporting vaccine administration codes

APCs Insider, March 9, 2012

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Q: We have been reporting the CPT® code for vaccine administration (90471) when administering the hepatitis B vaccine to patients. The Medicare Claims Processing Manual indicates this is appropriate. However, we have heard that a G-code should be reported instead. Which code is correct? 

A: HCPCS code G0010 (administration of hepatitis B vaccine) was reported on Medicare claims prior to January 2006 when the hepatitis B vaccine was administered. CMS changed the status indicator to B (codes not recognized by OPPS when submitted on an outpatient hospital Part B bill type) in January 2007 and instructed coders to report the appropriate CPT codes (90471, 90472) for this service.
CMS changed the status indicator for G0010 back to S (significant procedure, not discounted when multiple) retroactively to January 1, 2011, via Transmittal 2174 in March 2011.

CMS created a separate benefit category for the hepatitis B vaccine and waived the deductible and coinsurance. The status indicator change was necessary to identify the administration of the hepatitis B vaccine and enable the claims processing system to apply the waiver of the coinsurance and deductible to both the administration and the vaccine. Because these types of claims processing edits are based on reported codes, CMS cannot appropriately adjudicate claims without a specific HCPCS code for this service.

Transmittal 2390, issued January 25, indicates that CMS did not update the instructions in the Medicare Claims Processing Manual to reflect the change when it released the original transmittal and reactivated the code under the OPPS.

CMS is updating the instructions in Chapter 18, §10.2.1 to reflect the appropriate billing instructions. The edit will be effective July 2, 2012, according to Transmittal 2390. Providers aware of any claims that were adjudicated inappropriately should bring the claims to the attention of their FIs/MACs for correction.
Providers should immediately update their chargemasters to ensure that HCPCS code G0010 is reported for the administration of the hepatitis B vaccine.

Editor’s note: Andrea Clark, RHIA, CCS, CPCH, chairman, CEO, and founder ofHealth Revenue Assurance Associates, Inc., in Plantation, FL, answered this question.

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