Coding & Documentation

Cindy Hughes, CPC

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.

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.

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.