H1N1 Admin Code

 Brush Up Your Influenza Coding Options

All of the influenza codes all go to the same product code as there's one specific code for that. Here, we have Pentacel combination as well. Your claims are going to include multiple 90460s and 90461. You can combine only the 90461s for each vaccine. Read this healthcare coding article and know how you should not rule out all the vaccines initial and subsequent administration with counseling units and report them on two lines.

Insurers have indicated that this method will trigger denials as the insurer needs to be able to identify each vaccine administration grouping. As you see here, we've rolled up all the additional Pentacel components into one grouping and reported them on one line after the initial component.

The other vaccines have been listed out separately. So here we have one grouping, the Pentacel, another second grouping of the pneumonia and then a final one of the rotavirus.

And we're not adding each of these together that we would have four and then one, two, three of our base codes, we're instead reporting each one out.

Another thing to remember in order to avoid denials when you start using these neat new codes is since you have to line item these, you may have to use multiple claim forms. You're going to have with preventive medicine service is involving multiple vaccine; you may run over the allotted number of lines for that actual claim entry.

In these cases, make sure that you're breaking the healthcare coding claims by still keeping the groupings together. Otherwise, the insurer system could deny a subsequent code thinking that there's no associated initial code.

So here, we make sure to break it after this grouping. So here, we have a vaccine for pneumococcal vaccine serum and the component. So we have our product, our admin code.

Now, again, we break it here where we have our new product and new admin code. If we instead broke it here and between the rotavirus, then, or I'm sorry. If we broke it instead here between the additional one and had this on a new claim, the insurer might see that each additional add-on code first and not connected to the first component base code, thereby denying the Pentacel addition.

CPT 2011 will offer a specific code for H1N1 administration, 90470. The code covers both route of administration and includes counseling but you don’t actually need to put this on your super bill. You will not use this code for the flu vaccines that are available for the fall 2010 flu season.

Code 90470 is for H1N1 only, not H1N1 plus influenza. There are no current vaccine products for H1N1 only. H1N1 antigen is included in all the general flu vaccine products. You'll use 90460 for vaccine administration with counseling of products that contain influenza and H1N1.

ICD-9 2011, codes continue to become more and more specific, necessitating a provider to document clearly and thoroughly to allow for selection of the most specific and accurate code.

When a patient has H1N1, pay attention to two details. The medical record will have to identify the correct influenza and you will have to capture the appropriate manifestations to select the codes to the degree of specificity now required.

You don’t need to know whether the H1N1 is associated with pneumonia, upper respiratory infection for involved gastrointestinal problem.

With the changed category IV 888 which is influenza due to certain identified influenza viruses will mirror the structure of category IV 887. The current 488.X sub-category have been provided the level of detail for category IV 87.

ICD-9 2011 deletes 488.0 and 488.1 and adds six new five digits codes. The new codes 488.X and 488.X allow you to uniquely capture pneumonia of a respiratory manifestations and other manifestations occurring with these types of influenza. 2011 Family Practice Coding Update Page 23 of 28 Presenter: Jennifer Godreau, CPC, CPMA, CPEDC To purchase the audio version of this transcript, please call 800-508-2582.

Starting October 1st, you should have done assigning the correct code based on the type of co-morbid manifestation, the avian or H1N1 influenza involved. Sure you're looking that manifestation to assign with this digit.

Healthcare Coding Tip: But don’t forget, as with 487.0, when you code 488.01, 488.1, you need to use an additional code to identify the type of pneumonia.

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