CODING UPDATES 2011 & Introduction to ICD-10 CM 1 Local Health Operations Division of Administration and Financial Management Janet Overstreet/Cynthia Robinson February 2 nd, 2011

New FLU Vaccine Codes for Medicare Patients Medicare made changes to the CPT/HCPCS codes for FLU vaccines (previously reported as 90658) 448D-B26C-79192DA5D0B6/0/MM7234.pdf 448D-B26C-79192DA5D0B6/0/MM7234.pdf The new Medicare flu vaccine codes are to be reported for those flu shots given on or after 1/1/11. 2

New FLU Vaccine Codes for Medicare Patients Q Afluria- Influenza, 3yrs and ↑ Q Flulaval- Influenza, 3yrs and ↑ Q Fluvirin- Influenza, 3yrs and ↑ Q Fluzone- Influenza, 3yrs and ↑ Q NOS flu- Influenza, 3yrs and ↑ 3

New FLU Vaccine Codes for Medicare Patients The G0008 flu administration code is to be reported with the “Q” flu vaccine codes The Medicare reimbursement rates can be found on the revised “Influenza and Pneumonia Rates” on the LHO webpage under Updates and Alerts 4

New Vaccine Administration Codes “through age 18” Recommendations were made by the American Academy of Pediatrics (AAP) to the AMA to change the way vaccine administration are reported for “through age 18” that takes into account the professional time required to counsel parents or caregivers of children receiving the vaccine. That counseling includes an explanation of each component of a multiple-component vaccine. 5

New Vaccine Administration Codes “through age 18” The effective date to start reporting the new vaccine administration codes is 1/1/11 The new vaccine administration codes will be reported by “component” and not by “routine of administration” CPT defines a "component" as each antigen in a vaccine that prevents disease caused by one organism; combination vaccines contain multiple vaccine components 6

New Vaccine Administration Codes “through age 18” The new administration codes for “through age 18” are: for administration of immunizations to children through age 18 via any route of administration, with counseling provided by a physician or other qualified health care professional for the first vaccine or toxoid component; and for each additional vaccine or toxoid component that is listed separately and is in addition to the code for the primary procedure. 7

New Vaccine Administration Codes “through age 18” The should be reported every time a (single or combination) vaccine is administered; units are reported when more than one vaccine is administered. The 90461, add-on code, should be reported for each additional component of any combination vaccine; units are reported when there are more than one additional component. 8

New Vaccine Administration Codes “through age 18” EXAMPLE: DTaP/Hep B/IPV MMR Flu x 3units (Diphtheria, Measles, Flu) x 6units (Tetanus, Pertussis, Hep B, IPV, Mumps, Rubella) 9

How to Report Vaccine Administration ? When an immunization is the only service provided or when immunizations are provided along with WIC or another service where a separate E/M may not be reported; the (pseudo E/M) is to be used with reporting the vaccines and administration. 10

How to Report Vaccine Administration ? ICD-9 code V069- may be used to report the vaccines and it should be with the code. If a separate E/M is reported, would not be needed and the V069- should be listed as a secondary ICD-9. When the code and vaccines/administration are reported in addition to a WIC service; the and vaccine codes are to be reported first. LHDs billing insurance for vaccines & administration should contact those health plans to assure acceptable billing for the new CPT codes 11

Rates for the New Vaccine Administration Codes “through age 18” Self-pay rates will be assessed on the federal Uniformed Sliding Fee Schedule $6.00 (x units) $14.17 rev. 2/14/ $2.00 (x units).00 (VFC federal vaccine administration fee cap taken into consideration) It is important that LHDs accurately assess patient income. 12

Rates for the New Vaccine Administration Codes “through age 18” The rates listed below in the 501 Service File are based on the RBRVs: Medicare/InsuranceS22.00$11.00 Other (contract P8)$22.00$11.00 Fixed-Full Charge$22.00$11.00

What to do about those already reported with old administration codes? Encounters for services on or after 1/1/11 should be reported with the new vaccine administration codes. Changes to correct the encounter entries may result in lower, higher or same charges to the patient. 14

How will Medicaid & Passport reimburse for Vaccine Administration? There will be no changes in the way Medicaid and Passport are currently reimbursing for vaccine administration services The administration rate will continue to be paid on each vaccine code reported: Medicaid Preventive - $18.40 Passport - $5.00 $18.40 rev. 3/1/11 15

How to report vaccine administration for 19yrs and above OR 18yrs and under that did not receive the counseling? Vaccine administration codes for 19 years and above will remain the same and by route of administration (or 18yrs and under that did not receive the counseling by physician or other qualified health care professional) Immunization administration (includes percutaneous, intradermal, subcutaneous, and intramuscular); one vaccine (single or combination vaccine/toxoid) (Do not report in conjunction with 90473) 16

90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, and intramuscular); each additional vaccine (single or combination vaccine/toxoid (Use in conjunction with or 90473) Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid) (Do not report in conjunction with 90471) Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) (Use in conjunction with or 90473) 17

Rates for Vaccine Administration Codes Self-pay vaccines administration, using the vaccine administration codes, will be assessed to the patient on the federal Uniformed Sliding Fee Schedule or Fixed-Full Charge. The slide rate for & will be based on the VFC fee cap. Vaccine administration rates ( ) for insurance, contract, and fixed-full charge are based on the RBRVs. 18

Rates for Adult Vaccine Administration Codes The 501 Service File: Slide$21.85$11.03 Medicare/Insurance$21.85$11.03 Other (contract P8)$22.00$11.00 Fixed-Full Charge$22.00$ Slide$14.17$11.03 Medicare/Insurance$21.85$11.03 Other (contract P8)$22.00$11.00 Fixed-Full Charge$22.00$11.00

ICD-10 CM On October 1, 2013, the ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. To accommodate the ICD-10 code structure, the transaction standards used for electronic health care claims, Version 4010/4010A, must be upgraded to Version 5010 by January 1, This fact sheet provides background on the ICD-10 transition, general guidance on how to prepare for it, and resources for more information. Please see this website for further information regarding compliance timeline: et pdf et pdf 20

ICD-10 CM The transition to ICD-10 is occurring because ICD-9 produces limited data about patients’ medical conditions and hospital inpatient procedures. ICD-9 is 30 years old, has outdated terms, and is inconsistent with current medical practice. Also, the structure of ICD-9 limits the number of new codes that can be created, and many ICD-9 categories are full. 21

ICD-9 to ICD-10 GEM Examples: ICD9 ICD = E63.9 Nutritional deficiency, unspecified V2541 = Z30.41 Encounter for surveillance of contraceptive pills (Encounter for repeat prescription for contraceptive pill) V202- = Z Encounter for routine child health examination without abnormal findings (Encounter for routine child health examination NOS ) 22

ICD-9 to ICD-10 GEM Examples: Please see the following website to become familiar with ICD-10. Review the GEM’s and the Tabular list to make sure the ICD-10 is actually the correct diagnose. ICD10CM_and_GEMs.asp#TopOfPage 23

There will be a “Frequently Asked Question” document developed and located on the Local Health webpage at: Questions may be sent to the Local Health Help Desk at: 24