The Centers for Disease Control and Prevention (CDC) recommends everyone 6 months and older get a flu vaccine every season with rare exceptions. And this year, the CDC says getting a flu vaccine is even more important to protect against the flu and to help reduce the strain on health care systems. The College is here to help with tips on how to manage flu clinics during COVID-19, plus current coding and reimbursement information for flu vaccines.
Operationalizing your flu clinic
Flu clinics during COVID-19 take extra planning. Allergists can incorporate many of the same strategies they have been using for allergy shot clinics. Create a plan that works best for your practice based on COVID-19 prevalence in your area, your practice location, staffing and other factors. CDC strategies for immunization services include:
- Dedicating specific clinics or rooms for immunizations.
- Requiring advance appointments for flu shots to reduce the number of patients on site at any one time.
- Closing waiting rooms or registration areas.
- Having patients check in by phone and receive vaccinations from their vehicles in the parking lot.
Other ideas include:
- As an alternative to requiring appointments, consider having dedicated hours/days for walk-ins to increase convenience. Be sure to staff accordingly for quicker throughput.
- Consider holding a flu shot clinic outside under an open tent (with proper PPE and social distancing). Put biohazard signs on the tent to discourage people from stealing it (yes, that has happened!)
- If you need to have your clinic inside, think through how to do it safely. That may mean using exam rooms at the front of the building and/or your waiting room.
- If a patient is already in the office for a visit, encourage them to get their flu vaccine then. “We are encouraging patients to get the flu shot at the same visit as their allergy shot,” said Kevin McGrath, MD, FACAAI, chair of the Practice Management Committee.
- Send an email via your patient portal reminding patients about the importance of getting vaccinated and advising them of flu shot days/hours. Promote your flu clinic on your website and via social media.
- Consider promoting other flu shot clinics in your area. “Our clinic is located on the hospital campus, and many patients are hesitant to come into the hospital and have to go through COVID screening at the door. So, while we advertise that we can give flu shots as we always do, we also promote other options in the area. Kind of a ‘even if you don’t get it from us, get a flu shot somewhere’ approach,” said Melinda Rathkopf, MD, FACAAI, vice chair of the Practice Management Committee.
- Send CDC Influenza Vaccine Information Statements (VIS) to flu shot patients via your portal or secure text message. Have copies posted in the vaccination area for easy viewing. Statements include the VIS for Live, Intranasal Influenza Vaccine and the VIS for Inactivated or Recombinant Influenza Vaccine.
Coding for flu vaccine
The ICD-10 code to use for flu vaccination is Z23, encounter for immunization.
There are many CPT codes to describe influenza vaccine, varying by manufacturer, product and age group. Code according to the product you are using to accurately bill for flu vaccine. CMS provides 2020-2021 influenza CPT codes and Medicare reimbursement rates.
Coding for flu vaccine administration
There are several immunization administration codes you may need to use.
For Medicare patients, use the administration code G0008.
For non-Medicare patients:
If the patient receiving the influenza vaccine is 18 years of age or younger and receives counseling from a physician or other qualified health care professional (e.g., nurse practitioner), report 90460.
- 90460 – Immunization administration through 18 years of age via any route of administration, w/ counseling by physician or other qualified health care professional; first vaccine/toxoid component.
However, if both of the above criteria are not met, the immunization administration code reported must come from the 90471-90474 series.
- 90471 – Immunization administration (includes percutaneous, intradermal, subcutaneous or intramuscular injections); one vaccine (single or combination vaccine/toxoid).
- +90472 – Immunization administration; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to 90460, 90471 or 90473).
- 90473 – Immunization administration (by intranasal or oral route); one vaccine (single or combination vaccine/toxoid).
- +90474 – Immunization administration; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to 90460, 90471 or 90473).
Other considerations to keep in mind when reporting codes 90471-90474:
- If you administer an injection of the influenza vaccine only, report 90471.
- If you administer an influenza vaccine in addition to other vaccines, report the influenza injection with 90472.
- Note that code 90471 or 90473 cannot be reported in conjunction with 90460. Therefore, if during a single encounter, a patient receives multiple vaccines and there is counseling on all but the influenza vaccine, report 90472 or 90474 in addition to 90460 and 90461 as appropriate.
Providing the flu vaccine is more important than ever this year. Consider how best to make it work for your practice and your patients – and make sure you code for it correctly.