vaccine coding webinar - ccah-alliance.org
TRANSCRIPT
VACCINE CODING WEBINAR
Presented by:
Ashli Pickerill | Coding Resource Specialist | Quality Improvement
AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
IMPORTANCE
IMPORTANCE OF VACCINES
Protects individuals
from disease
Helps protect the community
Lowers healthcare
costs
Required for school
entry
VACCINES FOR CHILDREN
VACCINES FOR CHILDREN PROGRAM
Federally funded program
Vaccines provided at no cost to VFC providers
Free to Alliance members
Children 0-18 years of age
Are you a Vaccines for Children (VFC) provider?
POLL QUESTION #1
POLL QUESTION #1
BECOME A VFC PROVIDER
VFC PROVIDER
Contact your local VFC
Representative
Santa Cruz & Monterey Counties Brenton Louie
(Supervisor) (510) 412-1607 [email protected]
Veronica Martinez (510) 412-1602 [email protected]
Thyrone Antonio (510) 412-1609 [email protected]
Marcia Santillan (510) 412-1608 [email protected]
Merced County
Souk Mouanoutoua
(Supervisor) (559) 228-5855 [email protected]
Yunuen Garcia (559)228 5857 [email protected]
AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
BILLING
Immunizations billed with appropriate CPT
Modifier SL
Administration code not required
VACCINES FOR CHILDREN (VFC)
BILLING
VFC BILLING EXAMPLE
BILLING
Immunizations billed with appropriate CPT
Administration not required
Comments may be required
VACCINES: PURCHASED
BILLING
BILLING EXAMPLE: PURCHASED
AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
REIMBURSEMENT
VFC REIMBURSEMENT
Vaccine not reimbursable
Admin separately reimbursable
• Paid on vaccine claim line
PURCHASED REIMBURSEMENT
Vaccine reimbursable
Admin separately reimbursable
• Paid on vaccine claim line
REIMBURSEMENT
VFC REIMBURSEMENT PURCHASED REIMBURSEMENT
Code Reimbursement
90723 $100+$4.46 = $104.46
90707 $100+$4.46 = $104.46
90471* $0.00
90472* $0.00
Code Reimbursement
90723-SL $18
90707-SL $18
90471* $0.00
90472* $0.00
*Payment for the administration is paid on the vaccine claim line
AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
DENIALS
3S – Included in another service
5C – Missing modifier
5D – Incorrect modifier
5T – Service requires documentation
COMMON DENIALS
DENIALS
AVOIDING DENIALS
Bill with correct CPT codes and modifiers
Bill age appropriate CPT codes
When should pregnant
women receive the prenatal Tdap vaccine?
POLL QUESTION #2 POLL QUESTION #2
B. Between 27 and 36 weeks gestation.
POLL #2: ANSWER
POLL QUESTION #2
AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
VACCINE RECOMMENDATIONS
PRENATAL: TDAP & INFLUENZA
All pregnant women
Tdap: 27 through 36 weeks gestation
Flu: any trimester
Set up EHR flags
VACCINE RECOMMENDATIONS
HIGH RISK: ADULTS H
OM
ELES
S Hep A IM
MU
NO
CO
MP
RO
MIS
ED
HPV
Pneumococcal
Hep B
Meningococcal
(Men ACWY)
Td or Tdap
MSM
Hepatitis A
Hepatitis B
HPV
MeningB
VACCINE RECOMMENDATIONS
HIGH RISK: CHILDREN
• Keep children up-to-date • Include Prevnar 13
AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
INFLUENZA
2018-2019 INFLUENZA BILLING UPDATES
Vaccine Name Age Group CPT Code
Afluria® (IIV4) 5+ years 90686
Fluad® (IIV) 65+ years 90653
Fluarix® (IIV4) 6+ months 90686
Flublok® (RIV4) 18+ years 90682
Flucelvax® (ccIIV4) 4+ years 90674
4+ years 90756
Vaccine Name Age Group CPT Code
Flulaval® (IIV4) 6+ months 90686
6+ months 90688
Flumist® (LAIV4) 2-49 years 90672
Fluzone® (IIV4)
6-35 months 90685
3+ years 90686
6+ months 90688
RESOURCES
RESOURCES
Medi-Cal Provider Manual: Immunizations - https://files.medi-cal.ca.gov/.../immun_m00o03o04o11p00.doc
Medi-Cal Coverage of Immunizations - https://files.medi-cal.ca.gov/pubsdoco/medsupply/Medi-Cal_coverage_immunizations_faq.asp
CDC Vaccines - https://www.cdc.gov/vaccines/index.html
Vaccines For Children – https://files.medi-cal.ca.gov/...mtp/.../vaccine_m00o03o04o11.doc
General claims questions |Contact your Claims Services Representative
Any coding related questions | Contact Ashli Pickerill
Phone: 831-430-4111
Email: [email protected]
QUESTIONS?