3 EASY ORDERING METHODS: BILLING AND CODING GUIDE

[Pages:16]BILLING AND CODING GUIDE

2019-2020 INFLUENZA SEASON

Please see Important Safety Information on pages 6-8 and 13, and accompanying full Prescribing Information.

Coding for all Seqirus vaccines

Because there are many Current Procedural Terminology (CPT ) codes that describe influenza vaccines, accurate coding for influenza vaccines is critical. You must code correctly based on the product you are using to receive accurate payment.

THE GRID BELOW EXPLAINS HOW TO CODE FOR SEQIRUS VACCINES?-4

Seqirus Vaccine Product Description

2019-2020 NDC Carton

2019-2020 NDC Unit-of-Use

Presentation/ Dose

Age Indication

Vaccine Product Billing Code

CPT/Medicare Code

FLUAD? (influenza 70461-019-03 70461-019-04 Prefilled

65 years

vaccine, adjuvanted)

syringe 0.5 mL and older

90653 = Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use

90653

FLUCELVAX? QUADRIVALENT (influenza vaccine)

70461-319-03 70461-419-10

70461-319-04 70461-419-11

Prefilled syringe 4 years

0.5 mL

and older

Multidose vial 4 years

5 mL

and older

90674 90756

90674 = Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative- and antibiotic-free, 0.5 mL dosage, for intramuscular use

90756 = Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular usea

33332-219-20 33332-219-21

Prefilled syringe 6 through 90685

0.25 mL

35 months

AFLURIA? QUADRIVALENT (influenza vaccine)

33332-319-01 33332-419-10

33332-319-02 33332-419-11

Prefilled syringe 36 months

0.5 mL

and older

Multidose viala 5 mL

6 through 35 months

36 months and older

90686 90687 (0.25 mL dose) 90688 (0.5 mL dose)

90685 = influenza vaccine, quadrivalent (IIV4), split virus, preservative-free, 0.25 mL dosage, for intramuscular use 90686 = Influenza vaccine, quadrivalent (IIV4), split virus, preservative-free, 0.5 mL dosage, for intramuscular use 90687 = influenza vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use 90688 = Influenza vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use

NDC=National Drug Code. aNo more than 10 doses (0.25 mL or 0.5 mL) should be withdrawn from the Afluria Quadrivalent multidose vial.

Please see Important Safety Information on pages 6-8 and 13, and accompanying full Prescribing Information.

National Drug Codes change each year for influenza vaccines

The National Drug Codes (NDCs) for 2019-2020 Seqirus vaccines are listed in the grid to the left. Some Medicaid agencies and private health plans require the use of an 11-digit NDC in addition to the CPT code on claims for physician-administered products. However, Medicare and TriCare require both the current NDC and CPT code for billing influenza vaccines (eg, Fluad-70461-0019-03; the red shows where the additional zero needs to be added and is the same for all of our vaccines). Influenza vaccines are licensed each year with new NDCs, so it is important to report the correct code for the product you are using. Additionally, the US Food and Drug Administration (FDA) requires different NDCs on the cartons and the syringe or vial (unit-of-use), so it is important to record the correct NDC in the patient's record as per the standard procedure in your practice. For billing/claims processing for Seqirus influenza vaccines, the NDC from the carton should be used. If you have questions, call your payers to confirm their preferred NDC, either carton or unit-of-use.

DISCLAIMER: The billing and coding information contained in this document is presented as a resource and guide to billing and coding for AFLURIA

QUADRIVALENT (Influenza Vaccine), FLUCELVAX QUADRIVALENT (Influenza Vaccine), FLUAD (Influenza Vaccine, Adjuvanted), plus antiviral treatment RAPIVAB? (peramivir injection). Billing and coding information is gathered from several sources and is subject to change without notice. While every effort is made to ensure the accuracy of this information, appropriate billing and coding for health care services are the provider's responsibility and should always be based on the patient's clinical condition, services provided, and payer guidelines.

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Coding for the administration of Seqirus vaccines

The method of administration of Seqirus vaccines should be reported in addition to the vaccine product code. Assign the appropriate immunization administration code based on the documentation in the medical record. The following CPT codes are for vaccines administered via injection to individuals.5

CPT Code

Description

99213 90460

A mid-level outpatient or inpatient office visit. Level 3 code for an established patient (not for a new patient who has no history).

Immunization administration through 18 years of age via any route of administration with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered

90471

Immunization administration, 1 injection

90472 (add-on code)

Immunization administration, each additional injection

Medicare requires use of Healthcare Common Procedure Coding System (HCPCS) codes for the administration of the vaccines that they cover preventively, including influenza vaccine. HCPCS code G0008 must be used when billing Medicare for the administration of Seqirus vaccines, regardless of patient age or provider counseling. Some payers, including Medicare, may require that an HCPCS code be used instead of a CPT code to report the administration of influenza vaccines. See the grid below for more information on this code.6

Please see Important Safety Information on pages 6-8 and 13, and accompanying full Prescribing Information.

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HCPCS Code G0008

Description Seasonal influenza virus vaccine administration

Influenza vaccine International Classification of Diseases, Tenth Revision diagnosis codes

Below is a suggested International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code that may be appropriate when submitting claims for Seqirus vaccines and their administration. The code should be linked to both the vaccine and administration codes.5

ICD-10 Code Z23

Description Encounter for immunization

Use of modifiers when billing for vaccines

Vaccines are usually administered as a preventive service, but may also be administered as a problem-oriented evaluation and management (E/M) service. When a vaccine is administered and an illness, abnormality, or other problem is significant enough to require additional work, the modifier "25" should be attached to the office or other outpatient service code to indicate which E/M service was provided by the same physician on the same day as the preventive medicine service. Check with your payers to understand their coding requirements regarding use of the 25 modifier.5,7

For any reimbursement-related questions, customers may also call the Seqirus Customer Service Center at 855.358.8966, option #3.

FLUAD? (Influenza Vaccine, Adjuvanted) administered to a patient on Medicare

A 67-year-old man is seen at an urgent care facility after a fall. The physician recommends that he also receive an influenza vaccine and administers FLUAD.1,3,5,7-9

Z23 = encounter for immunization R29.6 = repeated falls 99281 = ER evaluation and management

90653 = FLUAD

G0008 = administration 3

FLUCELVAX? QUADRIVALENT (Influenza Vaccine) administered at a problem-focused visit

A 34-year-old woman is seen at the physician's office for evaluation of her asthmatic condition and related prescription refills. The physician recommends she receive an influenza vaccine and administers FLUCELVAX QUADRIVALENT.1,4,5,7,9

Please see Important Safety Information on pages 6-8 and 13, and accompanying full Prescribing Information.

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J45.40 = moderate persistent asthma, uncomplicated Z23 = encounter for immunization

99212 = established outpatient 90674 = FLUCELVAX QUADRIVALENT 90471 = administration

AFLURIA? QUADRIVALENT (Influenza Vaccine) vaccine administered at a well visit

A 28-year-old woman is seen for a well visit and receives a needleless influenza vaccination, AFLURIA QUADRIVALENT.1,2,5,7

99213 90686 90471

ICD-10: Z00.00 = encounter for routine adult health examination without abnormal findings

Z23 = encounter for immunization

99213 = mid-level outpatient or inpatient office visit. Level 3 code for an established patient 25 = modifier (See page 2: Use of modifiers when billing for vaccines)

90686 = AFLURIA QUADRIVALENT

90471 = administration

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INDICATIONS AND USAGE

FLUAD is an inactivated influenza vaccine indicated for active immunization against influenza disease caused by influenza virus subtypes A and type B contained in the vaccine. FLUAD is approved for use in persons 65 years of age and older.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

Severe allergic reaction to any component of the vaccine, including egg protein, or after a previous dose of any influenza vaccine.

WARNINGS AND PRECAUTIONS

? If Guillain-Barr? syndrome (GBS) has occurred within six weeks of previous influenza vaccination, the decision to give FLUAD should be based on careful consideration of the potential benefits and risks.

ADVERSE REACTIONS

? The most common (10%) local (injection site) adverse reactions observed in clinical studies were injection site pain (25%) and tenderness (21%).

? The most common (10%) systemic adverse reactions observed in clinical studies were myalgia (15%), headache (13%), and fatigue (13%).

To report SUSPECTED ADVERSE REACTIONS, contact Seqirus at 1-855-358-8966 or VAERS at 1-800-822-7967 and vaers..

For more information, please see accompanying US full Prescribing Information for FLUAD.

FLUAD? is a registered trademark of Seqirus UK Limited or its affiliates.

Please see Important Safety Information on pages 6-8 and 13, and accompanying full Prescribing Information.

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