Wednesday, June 26, 2019
Reimbursement Coding Articles

Coding Articles

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New Code Pairs Bundle E/M With Vaccine Admin

New code pairs added to the Jan. 1, 2013, version of the National Correct Coding Initiative (CCI Version 19.0) bundle E/M codes as components of vaccine administration codes 90460-90461, 90471-90474.
The new code pairs will permit you to unbundle them when appropriate. However, longstanding CCI coding rules caution against routine billing of E/M services with codes such as immunization administration, which have an XXX global surgery indicator.
Many XXX procedures have inherent pre-procedure, intra-procedure and post-procedure work that should never be reported as a separate E/M code, Chapter 11 of the CCI policy manual states.
For example, it would not be appropriate to separately report an E/M for immunization-related counseling by a physician or other qualified health professional in addition to pediatric administration codes 90460 and 90461, since these codes specifically include counseling.
In addition, A physician should never report a separate E/M code with these procedures for the supervision of others performing the procedure or for the interpretation of the procedure, the CCI manual states.
However, CCI will permit separate payment of significant and separately identifiable E/Ms on the same date as the immunization. This E/M service may be related to the same diagnosis necessitating performance of the XXX procedure but cannot include any work inherent in the XXX procedure, supervision of others performing the XXX procedure or time for interpreting the result of the XXX procedure, the CCI manual states.
Also in the vaccine section, CCI introduces edits to prevent payment for more than one flu shot for a single patient on the same calendar date. For example, influenza codes 90654-90668 now include Adjuvant Intramuscular Flu vaccine code 90653 as a component. Similarly, Quadrivalent flu vaccine code 90672 now includes flu codes 90653-90668 as components. The code pairs all have a 0 modifier indicator, so you may not append a modifier to override them.
CCI also added edits for the new two-dose Hepatitis B vaccine code. The code is now bundled as a component of other Hepatitis B codes 90636and 90740-90748, also with a 0 modifier indicator.


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