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Flu Shot CPT/HCPCS, ICD Codes with Medicare Allowables

<div dir="ltr" style="text-align: justify;" trbidi="on">Learn CPT Codes used for Medicare billing of Influenza Vaccines, commonly known as <b>Flu Shots</b>. You can also check out our article on <a href="http://www.medicalbillingcodings.org/2011/03/2010-2011-influenzapneumococcal-billing_12.html">Influenza/Pneumococcal Billing & Reimbursement</a> in 2011.<br />
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Influenza (flu), is a contagious respiratory illness caused by influenza viruses. There are over 200,000 hospitalizations from influenza annually. An average of 36,000 Americans die annually due to influenza and its complications, most are people 65 years of age and over. The best way to prevent the flu is to get vaccinated each year during the fall season.<br />
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Centers for Medicare & Medicaid Services (CMS) no longer recognize and reimburse CPT Code 90658 Influenza Virus Vaccine, Split Virus for flu shots. CMS has established five separate influenza vaccine HCPCS codes to distinguish between the brand-names of influenza vaccines for governmental tracking purposes. Make sure to use these new codes in your medical billing.<br />
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<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/05/flu-shot-cpthcpcsicd-codes-Medicare-Allowables.html"><img alt="EMR/EHR System Implementation Process" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjbHZhFAHq23ZYMzicWdfd6TUDN8nEl_39KfqBiGp7fYvHYw6MABfgd64KfhN8C0tbv7dp58FvSd-0Nr327axG4VN2YTRsBlyuNY7YAkKHWEFOwkybtiuF3abKPmufDMBpdQaq_2QembG0/s1600/Medicare-Flu-Shot-CPT-ICD-Codes.jpg" /></a></div><br />
The flu season extends from September to March. Seasonal flu vaccination should begin as soon as vaccine is available (usually early September) and continue throughout the flu season. Seasonal flu outbreaks can happen as early as October, and seasonal flu activity usually peaks during the winter. Most types of injections, including a vaccine like the flu shot, are billed using two codes: <br />
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<b>Part One</b>: A code for the flu vaccine itself, whether it is a liquid to be injected, or a mist that is to be inhaled. <br />
<b>Part Two</b>: A code for the administration of the injection BILLING FOR FLU SHOTS - BASICS<br />
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<h3>Who should be vaccinated</h3>Although it’s true that the vaccine does not protect 100% of those who get it, it does protect most from life-threatening illness. The advisory committee on immunization practices (ACIP) recommends universal seasonal flu vaccination for anyone age 6 months and older.<br />
<ol><li>It includes age 6 months through 4 years (59 months).</li>
<li>Older than 50 years with chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, neurologic, hematologic or metabolic disorders (including diabetes mellitus).</li>
<li>Pregnant women who are Immunosuppressed (including immunosuppression caused by medications or by human immunodeficiency virus)</li>
<li>Age 6 months through 18 years using long-term aspirin therapy and who might be at risk for experiencing REYE SYNDROME after flu virus infection.</li>
<li>Residents of nursing homes and other chronic care.</li>
<li>American Indian/Alaska Natives</li>
<li>Those who are morbidly obese</li>
</ol><br />
<h3>Flu Shot ICD Codes for Diagnoses</h3>Use ICD 9 diagnosis code V04.81 Prophylactic vaccination and inoculation against influenza. If you are giving Pneumococcus and Influenza vaccinations on the same date, use ICD code V06.6. When giving a vaccination at the same time as seeing a patient for a medically necessary office visit, use a modifier 25 on the E/M code and map the E/M to a diagnosis code that describes the reason for the visit.<br />
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<h3>New HCPCS Medicare Flu Shot Codes</h3>HCPCS Code G0008 Administration of Influenza Virus Vaccine must still be used for the administration of the flu vaccine for Medicare patients. Below are the most commonly used Medicare Flu Shots CPT Codes:<br />
<ul><li><b>Q2035 Afluria Vaccine</b><br />
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)<br />
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</li><li><b>Q2036 Flulaval Vaccine</b><br />
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)<br />
<br />
</li><li><b>Q2037 Fluvirin Vaccine</b><br />
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)<br />
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</li><li><b>Q2038 Fluzone Vaccine</b><br />
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)<br />
<br />
</li><li><b>Q2039 NOS (Not Otherwise Specified) Vaccine</b><br />
Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)<br />
</ul>
<h3>Medicare Allowable CPT/HCPCS Brand</h3>Some payers do not recognize the value of the administration of any vaccine, and will not pay a separate amount for administration, however, most payers, including Medicare, will reimburse for both the vaccine itself and the administration. Below are the CPT/HCPCS brand with their Medicare allowables against them for Medicare Flu Shots Reimbursement:
<ul><li>90654 Fluzone ($18.918)</li>
<li>90655 Fluzone ($17.243 )</li>
<li>90656 Afluria, Fluarix, Fluvirin, Fluzone ($12.398)</li>
<li>90657 Fluzone ($6.022 )</li>
<li>90658 Afluria, FluLavil, Fluvirin, Fluzone (See Q-codes below)</li>
<li>90661 Flucelvax (20.663)</li>
<li>90662 Fluzone ($31.823)</li>
<li>90672 FluMist ($24.596)</li>
<li>90673 FluBlok (Pending)</li>
<li>90685 Fluzone ($23.228)</li>
<li>90686 Fluarix, Fluzone ($19.409)</li>
<li>90687 Pending (Pending)</li>
<li>90688 FluLaval (Pending)</li>
<li>Q2033 Medicare: FluBlok (Pending)</li>
<li>Q2035 Medicare: Afluria ($11.543)</li>
<li>Q2036 Medicare: FluLaval ($8.579)</li>
<li>Q2037 Medicare: Fluvirin ($14.963)</li>
<li>Q2038 Medicare: Fluzone ($12.044)</li>
<li>Q2039 Medicare: Adult, not otherwise specified (locally determined)</li>
</ul>The national average for Medicare payment allowance may vary by geographical location and you will need to check the CMS Fee Schedule for your correct reimbursement rate. The HCPCS codes Q2035 & Q2039 do not have national payment limits and will be determined by the local Medicare carrier.
</div>

Flu Shot CPT/HCPCS, ICD Codes with Medicare Allowables

Learn CPT Codes used for Medicare billing of Influenza Vaccines, commonly known as Flu Shots. You can also check out our article on Influenza/Pneumococcal Billing & Reimbursement in 2011. Influenza (f…

CPT, ICD Codes for Hepatitis A,B,C Screening Tests

<div dir="ltr" style="text-align: justify;" trbidi="on">View CPT and ICD 9 Codes used for Hepatitis Screening Test (A, B, C) in Medical Billing Coding. Viral hepatitis is the leading cause of liver cancer and the most common reason for liver <br />
transplantation <br />
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<h3>Hepatitis A,B,C,D,E and Liver Diseases</h3>Hepatitis refer to inflammation of the liver that can caused by virus infections that affect the liver. Viral hepatitis is a relatively common disease (25 patients in every 100,000 citizens in the US) caused by a diverse group of hepatotropic agents that lead to liver inflammation and liver cell death. <br />
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There are five hepatitis virus types identified by A, B, C, D, and E. However the most common types are Hepatitis A, Hepatitis B (HBV)and Hepatitis C (HCV). Data from Center for Disease Prevention and Control (CDC) shows that hepatitis C is the most common chronic bloodborne pathogen in the US. <br />
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<div style="text-align:center"><a href="http://www.medicalbillingcodings.org/2014/05/CPT-ICD910-Hepatitis-ABC-Screening-Tests.html"><img alt="CPT, ICD Codes for Hepatitis A,B,C Screening Tests" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg9TyR4eW3t_DAPlYevVrNnxmN0eN5uWGAqUXHUstpxJeRwCNPN3HjEA2mQpe6lSrytM-a5PWePCV3gmZ1vba0V_x-dgotWHF-nhuLVS0aleL5eXSicV_TfFwtCsM7oxRgcm8wIXD6gXYYD/s1600/CPT-ICD-Codes-for-Hepatitis-A-B-C-Screening-Tests.jpg" /></a></div><br />
<b>Hepatitis D (HDV)</b> <br />
Hepatitis D, also known as "delta hepatitis," is a serious liver disease caused by infection with the Hepatitis D virus (HDV). This is an RNA virus structurally unrelated to the Hepatitis A, B, or C viruses. Hepatitis D, which can be acute or chronic, is uncommon in the United States. HDV is an incomplete virus that requires the helper function of HBV to replicate and only occurs among people who are infected with the Hepatitis B virus. <br />
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<b>Hepatitis E (HEV)</b> <br />
Hepatitis E is a liver disease caused by the Hepatitis E virus (HEV). HEV infection usually results in a self-limited, acute illness. It is widespread in the developing world. Hepatitis E is believed to be uncommon in the United States. When HEV infection does occur, it is usually the result of travel to a developing country where Hepatitis E is endemic. However, rare cases have been reported among persons with no history of travel to HEV-hyperendemic countries. <br />
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<h3>CPT Codes for Hepatitis C, B Screening Test</h3>The CDC has recommendations regarding Hepatitis screening for both hepatitis B and hepatitis C for persons at high risk for infection. In addition to that North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) has issued practice guidelines on "Diagnosis and Management of hepatitis C infection in infants, children, and adolescents".  <br />
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Following are the CPT Codes for Hepatitis C, B Screening procedure/test:<br />
<ul><li>86708 Hepatitis A antibody (HAAb); total</li>
<li>86709 Hepatitis A antibody (HAAb); IgM antibody</li>
<li>86704 Hepatitis B core antibody (HBcAb); total</li>
<li>86705 Hepatitis B core antibody (HBcAb); IgM antibody</li>
<li>86706 Hepatitis B surface antibody (HBsAb)</li>
<li>86707 Hepatitis Be antibody (HBeAb)</li>
<li>86803 Hepatitis C antibody;</li>
<li>86804 Hepatitis C antibody; confirmatory test (eg, immunoblot)</li>
<li>87340 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; hepatitis B surface antigen (HBsAg)</li>
<li>87341 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; hepatitis B surface antigen (HBsAg) neutralization</li>
<li>87350 Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple step method; hepatitis Be antigen (HBeAg)</li>
<li>87902 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus</li>
<li>87912 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis B virus</li>
</ul><br />
<h3>ICD 9 Codes for Hepatitis C (HCV) and Liver Disease</h3>Following are the ICD 9 Codes for the diagnosis of Hepatitis C and Liver diseases:<br />
<ul><li>V01.7 Contact with or exposure to communicable diseases, other viral diseases</li>
<li>V02.60 Viral hepatitis carrier, unspecified</li>
<li>V02.62 Hepatitis C carrier</li>
<li>V02.69 Other viral hepatitis carrier</li>
<li>V05.3 Need for prophylactic vaccination and inoculation against single disease: viral hepatitis</li>
<li>V08 Asymptomatic HIV infection status</li>
<li>V69.2 High-risk sexual behavior</li>
<li>V77.8 Screening for obesity</li>
<li>V79.1 Screening for alcoholism</li>
<li>042 Human immunodeficiency virus (HIV) disease</li>
<li>070.41 Acute hepatitis C with hepatic coma</li>
<li>070.44 Chronic hepatitis C with hepatic coma</li>
<li>070.51 Acute hepatitis C without mention of hepatic coma</li>
<li>070.54 Chronic hepatitis C without hepatic coma</li>
<li>070.70 Unspecified viral hepatitis C without hepatic coma</li>
<li>070.71 Unspecified viral hepatitis C with hepatic coma</li>
<li>305.00 Nondependent alcohol abuse unspecified drinking behavior</li>
<li>305.01 Nondependent alcohol abuse continuous drinking behavior</li>
<li>305.02 Nondependent alcohol abuse episodic drinking behavior</li>
<li>305.03 Nondependent alcohol abuse in remission</li>
<li>571.5 Cirrhosis without alcohol</li>
<li>571.8 Other chronic nonalcoholic liver disease</li>
<li>571.9 Unspecified chronic liver disease without the mention of alcohol</li>
</ul><br />
If you think you are at risk for HCV, HBV or wish to be screened, please tell your doctor that you want to be sure about your status. He/she will comply with your wishes and work around any issues regarding inadequate diagnostic screening codes for hepatitis C or hepatitis B.<br />
</div>

CPT, ICD Codes for Hepatitis A,B,C Screening Tests

View CPT and ICD 9 Codes used for Hepatitis Screening Test (A, B, C) in Medical Billing Coding. Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantati…

CDT Dental Procedure Codes Changes 2014

<div dir="ltr" style="text-align: justify;" trbidi="on">Learn about new CDT Dental Procedure Codes Changes, effect from January 1, 2014. These new codes represent a major shift by the ADA to recognize Caries Management by Risk Assessment (CAMBRA). <br />
<br />
The American dental association updates the Current Dental terminology CDT procedure codes as a way of keeping up with the always changing tune in dental practice. Checkout this excellent learning presentation on <a href="http://www.ihs.gov/doh/edr/documents/CDT%202014%20Coding%20Updates.pdf">CDT Coding Updates 2014</a>.<br />
<br />
<div style="text-align:center;"><a href="http://www.medicalbillingcodings.org/2014/05/cdt-dental-procedure-codes-changes-2014.html"><img alt="CDT Dental Procedure Codes Changes 2014" border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgeLRviNu6aB2itpGNNbYN9dhpVl_TYxxL7CfKTRkxUZr9So6H5iKc5h0sZ0rU2q28JGk810CTzAIpuHXZMyW8sITAVFoWFJWBNjebs8ZwwcvbVMgTJq7M9b471g7XozXyqT2GPOHSp1rBH/s1600/CDT-Dental-Procedure-Codes-Changes2014.png" /></a></div><br />
Dentists and dental benefit companies are always required to use latest codes whenever they’re submitting process claims for reimbursement of claims. Dental Procedure Codes are normally developed to be in line with how dentistry is done in the real world.<br />
<br />
<h3>CDT Dental Procedure Codes Changes 2014</h3>The new Dental Procedure codes changes for 2014 entail the following:<br />
<ol><li>New Dental Procedure Codes (29)</li>
<li>Revised Dental Procedure Codes (18)</li>
<li>Deleted Dental Procedure Codes (4)</li>
<li>Subcategories and Descriptors Changes (7)</li>
</ol><h4>New Dental Procedure Codes 2014</h4>The American Dental association has added a total of 29 new procedure codes that can be used for different dental cases. Treatment using 3D simulations image volumes is one of the advancement in technology that is picking up in the Dentistry filed, procedures using this technology will be coded with CDT code D0393. Digital subtraction of image volumes of the same modality will be enlisted under the code D0394. <br />
<br />
D2921 is a billing dentistry code that will be used for reattachment of tooth fragment, incisal edge cusp, D2941 will be used for interim therapeutic restoration –primary tooth with D3427 tube used for Periradicular surgery without apicoectomy. The use of biological material to aid in soft osseous tissue regeneration in conjunction with perpendicular surgery should prompt coders to use D3431<br />
<br />
Guided tissue regeneration, resorbable barrier per site in conjunction with Periradicular are expected to be recorded using CDT code D3432. Pulpal regeneration for interim medication replacement will use CDT code D3356 with Bone graft in conjunction with Periradicular surgery per tooth relying on CDT code D3428. Below is the complete list of 29 new CDT Procedure Codes:<br />
<ol><li>D0393 Treatment simulation using 3D image volume</li>
<li>D0394 Digital subtraction of 2 or more images or image volumes of the same modality</li>
<li>D0395 Fusion of 2 or more 3D image volumes of 1 or more modalities</li>
<li>D0601 Caries risk assessment and documentation, with a finding of low risk</li>
<li>D0602 Caries risk assessment and documentation, with a finding of moderate risk</li>
<li>D0603 Caries risk assessment and documentation, with a finding of high risk</li>
<li>D1999 Unspecified preventive procedure, by report</li>
<li>D2921 Reattachment of tooth fragment, incisal edge or cusp</li>
<li>D2941 Interim therapeutic restoration</li>
<li>D2949 Restorative foundation for an indirect restoration</li>
<li>D3355 Pulpal regeneration - initial visit</li>
<li>D3356 Pulpal regeneration - interim medication replacement</li>
<li>D3357 Pulpal regeneration - completion of treatment</li>
<li>D3427 Periradicular surgery without apicoectomy</li>
<li>D3428 Bone graft in conjuntion with periradicular surgery - per tooth, single site</li>
<li>D3429 Bone graft in conjuntion with periradicular surgery - each additional contiguous tooth in the same surgical site</li>
<li>D3431 Biologic materials to aid in soft and osseous tissue regeneration in conjunction with periradicular surgery</li>
<li>D3432 Guided tissue regeneration, resorbable barrier, per site, in conjunction with periradicular surgery</li>
<li>D4921 Gingival irrigation - per quad</li>
<li>D5863 Overdenture - complete maxillary</li>
<li>D5864 Overdenture - partial maxillary</li>
<li>D5865 Overdenture - complete mandibular</li>
<li>D5866 Overdenture - partial mandibular</li>
<li>D5994 Periodontal medicament carrier with peripheral seal - laboratory processed</li>
<li>D6011 Second stage implant</li>
<li>D6013 Surgical placement of mini implant</li>
<li>D6052 Semi-precision attachment abutment</li>
<li>D8694 Repair of fixed retainers, includes reattachment</li>
<li>D9985 Sales tax</li>
</ol><br />
<h4>Revised Dental Procedure Codes</h4>Revisions have been made to the 2014 nomenclature and/or descriptor for the codes listed below. Please refer to your ADA CDT<br />
2014: Dental Procedure Code manual for specific details regarding these revisions.<br />
The revised CDT Codes are D0350, D2950, D3351, D3352, D3410, D3421, D3425, D3426, D4263, D4264, D4920, D5991, D6010, D6080, D7950, D7953, D7955, and D8693.<br />
<br />
<h4>Deleted Dental Procedure Codes</h4>The changes in CDT 2014 has also seen some codes being deleted and replaced by four other new ones. In this case, D0363 will be used for three dimensional image reconstruction using existing data including multiple images replaced by multiple existing codes. <br />
<br />
CDT code D0363 that was used for cone beam three dimensional image reconstruction has been deleted. D3354 previously used for Pulpal regeneration has also been deleted as well as D5860 for Overdenture- complete by report and D561 Overdenture- Partial, by report. There are following four deleted dental procedure codes:<br />
<ul><li>D3354 Pulpal regeneration replaces D3355 Pulpal regeneration.  <br />
</li><li>D3354 Pulpal regeneration; replaced by D3355 Pulpal regeneration – initial visit; D3356 Pulpal regeneration – interim medication replacement; or D3357 Pulpal regeneration – completion of treatment<br />
</li><li>D5860 Over denture – complete, by report; replaced by D5863 Overdenture – complete maxillary, or D5865 Overdenture - complete mandibular<br />
</li><li>D5861 Overdenture – partial, by report; replaced by D5864 Overdenture – partial maxillary, or D5866 Overdenture – partial mandibular</li>
</ul></div>

CDT Dental Procedure Codes Changes 2014

Learn about new CDT Dental Procedure Codes Changes, effect from January 1, 2014. These new codes represent a major shift by the ADA to recognize Caries Management by Risk Assessment (CAMBRA). The Ame…

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Flu Shot CPT/HCPCS, ICD Codes with Medicare Allowables

CPT, ICD Codes for Hepatitis A,B,C Screening Tests

CDT Dental Procedure Codes Changes 2014

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