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American Academy of Family Physicians
Thursday Aug 26, 2010

Organize to immunize - Flu season is coming

The CDC has announced approval of the 2010-2011 seasonal influenza vaccines. These vaccines will protect against the following viruses:

• A/California/7/09 (H1N1)-like virus (pandemic H1N1 2009 influenza virus),

• A/Perth /16/2009 (H3N2)-like virus, and

• B/Brisbane/60/2008-like virus.

Consult the CDC's Advisory Committee on Immunization Practices (ACIP) recommended vaccines table for more information about this year's vaccines, including an advisory against the use of Afluria in children aged 6 months through 8 years of age during 2010-2011. This advice is the result of an increased frequency of febrile seizures reported among young children (mostly among children aged < 5 years) in Australia in 2010.

If you plan to offer vaccinations in your practice and you've not yet ordered influenza vaccines, you can find the manufacturer-reported, average private-sector sales price in the CDC Vaccine Price List and use these prices as a reference when purchasing. (Prices may vary depending on quantity purchased, special offers, group purchasing, etc.) For information on managing purchasing, storing and billing for vaccines, check out these articles: Vaccination Management: Is your Practice on Target (from FPM) and Managing Vaccine Costs Ensures FPs Can Offer Patients Access to Needed Immunizations (from AAFP News Now).

It is important to note that even though H1N1 is a component of the seasonal vaccines, this does not require separate coding of the H1N1 component. The WHO has declared the H1N1 pandemic over and you should report only the seasonal flu vaccine code and the associated administration code for the 2010-2011 seasonal flu vaccines. Don't report the specific codes developed last year for H1N1 only or the new codes for reporting pandemic influenza vaccines.

Below are some quick coding tips for the 2010-2011 influenza seasonal vaccine. Correct codes for administration include the following:

• G0008, Administration of influenza virus vaccine,

• 90465, Immunization administration, younger than 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family: first injection (single or combination vaccine/toxoid), per day,

• 90466, each additional injection (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure),

• 90467, Immunization administration younger than age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family: first administration (single or combination vaccine/toxoid), per day,

• 90468, each additional administration (single or combination vaccine/toxoid), per day (List separately in addition to code for primary procedure),

• 90471,  Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections): 1 vaccine (single or combination vaccine/toxoid),

• 90472, each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure),

• 90473, Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid),

• 90474, each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).

For seasonal vaccine products, report the following codes:

• 90655, Influenza virus vaccine, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use,

• 90656, Influenza virus vaccine, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use,

• 90657, Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use,

• 90658, Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use,

• 90660, Influenza virus vaccine, live, for intranasal use.

• Also, a new high dose influenza vaccine is planned to be available during this year's season: 90662, Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use.

Diagnosis codes include the following:

• V04.81, Need for prophylactic vaccination and inoculation against viral diseases; influenza,

• V06.6, Need for prophylactic vaccination and inoculation against combinations of diseases; Streptococcus pneumoniae (pneumococcus) and influenza.

In addition to this watch for more information around October 1st regarding Medicare's coverage and payment for the influenza vaccines and administrations.

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