vaccine coding webinar - ccah-alliance.org
TRANSCRIPT
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VACCINE CODING WEBINAR
Presented by:
Ashli Pickerill | Coding Resource Specialist | Quality Improvement
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AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
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IMPORTANCE
IMPORTANCE OF VACCINES
Protects individuals
from disease
Helps protect the community
Lowers healthcare
costs
Required for school
entry
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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
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Are you a Vaccines for Children (VFC) provider?
POLL QUESTION #1
POLL QUESTION #1
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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]
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AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
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BILLING
Immunizations billed with appropriate CPT
Modifier SL
Administration code not required
VACCINES FOR CHILDREN (VFC)
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BILLING
VFC BILLING EXAMPLE
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BILLING
Immunizations billed with appropriate CPT
Administration not required
Comments may be required
VACCINES: PURCHASED
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BILLING
BILLING EXAMPLE: PURCHASED
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AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
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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
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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
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AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
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DENIALS
3S – Included in another service
5C – Missing modifier
5D – Incorrect modifier
5T – Service requires documentation
COMMON DENIALS
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DENIALS
AVOIDING DENIALS
Bill with correct CPT codes and modifiers
Bill age appropriate CPT codes
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When should pregnant
women receive the prenatal Tdap vaccine?
POLL QUESTION #2 POLL QUESTION #2
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B. Between 27 and 36 weeks gestation.
POLL #2: ANSWER
POLL QUESTION #2
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AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
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VACCINE RECOMMENDATIONS
PRENATAL: TDAP & INFLUENZA
All pregnant women
Tdap: 27 through 36 weeks gestation
Flu: any trimester
Set up EHR flags
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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
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VACCINE RECOMMENDATIONS
HIGH RISK: CHILDREN
• Keep children up-to-date • Include Prevnar 13
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AGENDA VACCINE BILLING
VACCINE REIMBURSEMENT
DENIALS
VACCINE RECOMMENDATIONS
FLU VACCINE BILLING &
RESOURCES
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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
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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
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General claims questions |Contact your Claims Services Representative
Any coding related questions | Contact Ashli Pickerill
Phone: 831-430-4111
Email: [email protected]
QUESTIONS?