CODING & DOCUMENTATION
Fam Pract Manag. 2006 Jan;13(1):24.
- Vaccination codes for Hib and influenza
- Penile nerve blocks during a circumcision
- Charging for a sterile surgical pack
Vaccination codes for Hib and influenza
What codes should I use to bill for the Haemophilus influenzae type b vaccines? Which should I use for the influenza virus vaccine?
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
When I use a penile nerve block as anesthesia during a circumcision, can I bill separately for the block?
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
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?
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.
WE WANT TO HEAR FROM YOU
Send questions and comments to email@example.com, 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.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact firstname.lastname@example.org for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions
More in FPM
Related Topic Searches
MOST RECENT ISSUE
Access the latest issue
of FPM journal
The Adolescent Health Consortium Project has clarified clinical preventive service recommendations for adolescents and young adults.
Here's how to succeed in the four performance categories of the Merit-based Incentive Payment System.