Jan 2006 Table of Contents

CODING & DOCUMENTATION



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Fam Pract Manag. 2006 Jan;13(1):24.

This content conforms to AAFP CME criteria. See FPM CME Quiz.

Vaccination codes for Hib and influenza

Q

What codes should I use to bill for the Haemophilus influenzae type b vaccines? Which should I use for the influenza virus vaccine?

A

Here are the CPT codes for selected Hib and influenza vaccines, listed by brand name:

90645 HibTiter, Hib vaccine, HbOC conjugate;

90646 ProHIBit, Hib vaccine, PRP-D conjugate;

90647 PedvaxHIB, Hib vaccine, PRP-OMP conjugate;

90648 ActHIB, Hib vaccine, PRP-T conjugate;

90657 Fluzone (not preservative free), influenza virus vaccine, split virus, for children 6–35 months of age, for intramuscular use;

90658 Fluzone (not preservative free), influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use;

90655 Fluzone Preservative Free, influenza virus vaccine, split virus, preservative free, for children 6–35 months of age, for intramuscular use;

90656 Fluzone Preservative Free, influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use;

90656 Fluarix, influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use;

90656 Fluvirin Preservative Free, influenza virus vaccine, split virus, preservative free, for use in individuals 3 years and above, for intramuscular use;

90660 Flumist, influenza virus vaccine, live, for intranasal use.

Don’t forget to bill the appropriate codes for the administration of the vaccines, 90465–90474, or, for Medicare patients receiving an influenza vaccine, HCPCS code G0008.

If a significant, separately identifiable evaluation and management (E/M) service other than 99211 is provided on the same date as the vaccination, submit the appropriate E/M code with modifier -25 attached. Medicare will reimburse for this in 2006. Unfortunately, some payers will bundle the administration code into the E/M visit.

Penile nerve blocks during a circumcision

Q

When I use a penile nerve block as anesthesia during a circumcision, can I bill separately for the block?

A

Yes. According to CPT, the surgical package includes local infiltration, metacarpal/metatarsal/digital or topical anesthesia. A penile nerve block would be a regional anesthesia procedure and separately billable. There is no specific code for a penile nerve block so you would code 64450, “Injection, anesthetic agent; other peripheral nerve or branch.” You should append modifier -47 to indicate anesthesia by the physician performing the procedure.

Charging for a sterile surgical pack

Q

Can I charge a separate fee for a sterile surgical pack to repair a laceration, or is that included with the cost of the repair?

A

No, you cannot charge a separate fee. The expense of the surgical tray is factored into the reimbursement provided for the surgical procedure code.

About the Author

Cindy Hughes is the coding and compliance specialist for the AAFP and is a contributing editor to Family Practice Management. Conflicts of interest: none reported. These questions and answers were reviewed by members of the FPM Coding & Documentation Review Panel, which includes: Robert H. Bosl, MD, FAAFP; Marie Felger, CPC, CCS-P; Thomas A. Felger, MD, DABFP, CMCM; David Filipi, MD, MBA, and the Coding and Compliance Department of Physicians Clinic; Emily Hill, PA-C; Joy Newby, LPN, CPC; P. Lynn Sallings, CPC; and Susan Welsh, CPC.

Editor’s note: While this department attempts to provide accurate information and useful advice, third-party payers may not accept the coding and documentation recommended. You should refer to the current CPT and ICD-9 manuals and the Documentation Guidelines for Evaluation and Management Services for the most detailed and up-to-date information.

 

WE WANT TO HEAR FROM YOU

Send questions and comments to fpmedit@aafp.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.

Copyright © 2006 by the American Academy of Family Physicians.
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