Axe 90658 for Medicare Patients In Favor Of Just-In Q Codes

Medical Coding: Medicare will no longer pay you money for 90658 with effect from January 1, 2011.

The new year brings changes to flu vaccines and counseling codes.

Your vaccine coding in 2011 will be on its toes, thanks to changes in codes and administration reporting. Two more updates every family physician should know involve new Q codes for some Medicare flu vaccines and expanded ages for adolescent vaccine counseling.

Nix 90658 for Medicare patients

CMS has come up with New HCPCS codes and payment allowances to replace 90658. Medicare will no longer pay you money for 90658 with effect from January 1, 2011. As such, select from the new codes instead, based on the specific product: Q2035, Q2036, Q2037, Q2038, Q2039.

Timing: Codes Q2035-Q2039 went into effect on October 1, 2010. When filing claims for DOS from October 1 until December 31, 2010: bill Medicare immediately with 90658, or hold the claim until January 1, 2011 and file with the proper Q code.

Explanation: Medicare pays for influenza vaccine based on 95 percent of the average wholesale price. The products normally classifiable to 90658 have widely varying AWPs. If Medicare continued paying for all of them under a single code, they could be overpaying some and underpaying others, relatively.

Consequence: Medicare assigns different Q codes to each individual product starting January 1, 2011 to account for variances in manufacturing prices. "This should actually ensure that physicians are paid well for products that might have significant differences.

Report 90460, +90461 through age 18

You will be able to use medicine series vaccine administration with counseling codes on older patients and when a nurse provides the counseling, thanks to CPT 2011.

As counseling for adolescents can involve as much as counseling on vaccine for younger children, the American Academy of Pediatrics recommended that the age limitation on the vaccine administration with counseling codes be raised. New codes extend vaccine administration with counseling to patients through 18 years of age.

Benefit from RN/LPN counseling and still get the reimbursements

Busy practices will be excited at being able to use their registered nurses (RN) or licensed practicing nurses (LPN) to capture the higher RVUs some private payers associate with the vaccine administration with counseling codes. The just-in vaccine administation code with counseling code descriptor expands who can provide the vaccine counseling described in the deleted immunization administration with vaccine counseling codes (90465-90468). CPT 2010 vaccine administration with counseling codes 90465-90468 limited the counselor role to a doctor and, subject to state scope of practice laws, nurse practitioner (NP) or physician assistant (PA).

Final say: Remember the just-in administration codes 90460 and 90461 are per vaccine/toxoid component. That means if your doctor provides counseling and administration for a combination, you will report 90460 for the first component and 90461 for each additional component. In the MMR example, you would use 90460 once and 90461 twice. Before 2011, you'd report only a single vaccine administration code for a combination vaccine, irresespective of the number of components in the vaccine.