2016-2017 PROPER CODING - VaccineShoppe.com

1 2016 - 2017 PROPER CODINGof Sanofi Pasteur ProductsEffective July 1, 2016 through June 30, 2017 Visit the Reimbursement Page on for additional CODING and billing resources for Sanofi Pasteur you have questions on coverage and payment for Sanofi Pasteur products?Contact the Sanofi Pasteur Reimbursement Support Service (RSS)Call 1-800-VACCINE (1-800-822-2463) and choose the prompt for the DescriptionCarton NDCaUnit-of-Use (vial or syringe) NDCa CPT b CodeVaccine Administration CPT CodescTypical ICD-10-CM CodePatients 0-18 Years of Age With Qualified CounselingcPatients 0-18 Years of Age Without Qualified CounselingcPatients 19 Years of Age and Older, With or Without Qualified CouselingcActHIB Haemophilus b Conjugate Vaccine (Tetanus Toxoid Conjugate)49281-0545-03d49281-0547-58 (powder)49281-0546-58d (diluent)90648 90460 - 1 unit90471/90472N/A due to age indicationZ23 Adacel Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine Adsorbed49281-0400-10 49281-0400-1549281-0400-5849281-0400-889 071590460 - 1 unit90461 - 2 units90471/9047290471/90472Z23eDAPTACEL Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine Adsorbed49281-0286-10 49281-0286-589070090460 - 1 unit90461 - 2 units90471/90472N/A due to age indicationZ23 Diphtheria and TetanusDiphtheria and Tetanus Toxoids Adsorbed (DT)49281-0225-1049281-0225-589070290460 - 1 unit90461 - 1 unit90471/9047290471/90472Z23eFluzone High-DoseInfluenza Vaccine 49281-0399-65f49281-0399-88f90662N/A due to age indication90471/90472 G0008 (Medicareg)90471/90472 G0008 (Medicareg)

2 Z23hFluzone Intradermal QuadrivalentInfluenza Vaccine49281-0710-40f49281-0710-48f90630 90460 - 1 unitG0008 (Medicareg)90471/90472G0008 (Medicareg)90471/90472G0008 (Medicareg)Z23hFluzone QuadrivalentInfluenza Vaccine, No Preservative: Pediatric Dose49281-0516-25f49281-0516-00f90685 ( mL dose)90460 - 1 unitG0008 (Medicareg)90471/90472G0008 (Medicareg)N/A due to age indication for mL doseZ23hFluzone QuadrivalentInfluenza Vaccine, No Preservative49281-0416-50f49281-0416-10f 49281-0416-88f49281-0416-58f90686( mL dose)90460 - 1 unitG0008 (Medicareg)90471/90472G0008 (Medicareg)90471/90472G0008 (Medicareg)Z23hFluzone QuadrivalentInfluenza Vaccine49281-0625-15f49281-0625-78f90687 ( mL dose)90460 - 1 unitG0008 (Medicareg)90471/90472 G0008 (Medicareg)N/A due to age indication for mL doseZ23hFluzone QuadrivalentInfluenza Vaccine49281-0625-15f49281-0625-78f90688 ( mL dose)90460 - 1 unitG0008 (Medicareg)90471/90472 G0008 (Medicareg)90471/90472 G0008 (Medicareg)Z23hImogam Rabies-HTRabies Immune Globulin (Human) USP, Heat RABIESR abies Vaccine49281-0250-5149281-0248-58 (powder)49281-0249-01 (diluent)

3 9067590460 - 1 unit90471/9047290471/90472Z23 IPOL Poliovirus Vaccine Inactivated49281-0860-1049281-0860-78907 1390460 - 1 unit90471/9047290471/90472Z23 Menactra Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine49281-0589-0549281-0589-589073490 460 - 1 unit90471/9047290471/90472Z23 Menomune -A/C/Y/W-135 Meningococcal Polysaccharide Vaccine, Groups A, C, Y and W-135 Combined49281-0489-0149281-0487-58907339 0460 - 1 unit90471/9047290471/90472Z23 Pentacel Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed, Inactivated Poliovirus and Haemophilus b Conjugate (Tetanus Toxoid Conjugate) Vaccine49281-0510-05 49281-0545-15 (ActHIB vaccine)49281-0560-05 (DTaP/IPV)9069890460 - 1 unit90461 - 4 units90471/90472N/A due to age indicationZ23 Quadracel Diphtheria and Tetanus Toxoids and Acellular Pertussis Adsorbed and Inactivated Poliovirus Vaccine49281-0562-1049281-0562-589069690 460 1 unit90461 3 units90471/90472N/A due to age indicationZ23 TENIVAC Tetanus and Diphtheria Toxoids Adsorbed49281-0215-1049281-0215-1549281- 0215-5849281-0215-889071490460 - 1 unit90461 - 1 unit90471/9047290471/90472Z23eTUBERSOL Tuberculin Purified Protein Derivative (Mantoux)49281-0752-21 49281-0752-22 Vi Typhoid Vi Polysaccharide Vaccine49281-0790-51 49281-0790-2049281-0790-8849281-0790-389 069190460 - 1 unit90471/9047290471/90472Z23YF-VAX Yellow Fever Vaccine49281-0915-05 (vaccine)49281-0912-03 (diluent)49281-0915-01 (vaccine)49281-0912-01 (diluent)49281-0915-68 (vaccine) 49281-0912-68 (diluent)49281-0915-58 (vaccine)49281-0912-58 (diluent)

4 9071790460 - 1 unit90471/9047290471/90472Z23 Note that correct CODING and billing will depend on the requirements of the third party payer being billed. It is always best that the provider check with the payer they are billing for specific If any of your payers require the NDC on a claim, check with them to confirm which NDC should be recorded, the carton or CPT (Current Procedural Terminology) is a registered trademark of the American Medical Refer to the back of this brohure for more information on CODING for vaccine administration and how to correctly use the administration CPT codes based on the vaccine The NDCs for the ActHIB vaccine carton and diluent vial changed in late May 2016 . Product received prior to May 2016 will have the previous NDC. Please confirm that you are using the correct NDC When tetanus products are given as treatment for woundcare, use a primary ICD-10 code which describes the patient s NDC numbers supplied for influenza virus vaccine are the 2016 - 2017 formulation.

5 Note that although NDC numbers change each influenza season, the product CPT and administration CPT codes remain Medicare requires the use of G0008 when billing for the administration of all influenza vaccines. All other administration codes will be When influenza vaccine is given to a high-risk patient, consider a secondary ICD-10 code describing the high-risk CODING for Imogam Rabies Immune Globulin is based on the units administered. Dosage is 9 IU per pound of patient weight, and a billable unit is equal to 150 IU of product. Refer to Reimbursement Information on for further PASTEUR. DiscoveryDrive. Swiftwater, Pennsylvania 18370. meet the reporting requirements of immunization registries, vaccine distribution programs, and reporting systems, the exact vaccine product administered needs to be reported. Separate codes for a particular vaccine are provided in the American Medical Association s (AMA) CPT when the schedule (number of doses or timing) differs for 2 or more products of the same vaccine type, or when the vaccine is available in more than 1 chemical formulation, dosage, or route of administration.

6 Such is the case with Haemophilus b vaccine, due to the differences in conjugated proteins and administration schedule. Specific CPT codes are available for combination vaccines. It is inappropriate to code each component of a combination vaccine separately. If a specific code for a vaccine product is not available, the unlisted procedure code (90749) should be used. A description of the vaccine or toxoid administered must be included on the claim to identify the product codes (90476 90749) are used to identify the vaccine product only. To report the administration of a vaccine or toxoid, an immunization administration code must also be reported (see below CODING for Immunization Administration).An immunization administration code must be reported in addition to the vaccine or toxoid product code in order to be paid for the administration service. There are 2 code sets that may be used when billing for administration, depending on the age of the patient and whether or not counseling was the patient is 18 years of age or under, and counseling was performed by the physician or other qualified health care professional, component-based administration codes are used.

7 These codes are based on the number of components in the vaccine, and a unit of administration is billed for each component. A component is defined as each disease for which the vaccine is intended to provide protection. These codes apply to all routes of administration, including injectable, intranasal, and oral. 90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered. 90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered. Example: All flu vaccines are intended to offer protection against 1 disease, influenza, and are considered single-component vaccines billed with 1 unit of 90460.

8 Example: Pentacel vaccine is intended to protect against 5 diseases, diphtheria, tetanus, acellular pertussis, polio, and Haemophilus b influenza and is considered a 5-component vaccine. Bill 1 unit of 90460 and 4 units of 90461. If the patient is 19 years of age or over, or if they are 18 years of age or under and counseling was not performed, use the code set that is based on number of injections administered at that visit (90471 90472). Note that because all Sanofi Pasteur vaccines are injectable, only 90471 and 90472 are applicable. (Products administered via oral or intranasal use 90473-90474.) 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid). 90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) Example: Fluzone and Adacel vaccines are administered to a patient that is 25 years of age.

9 Bill 1 unit of 90471 for the Fluzone vaccine and 1 unit of 90472 for the Adacel vaccine. MKT29696-1-1R 2016 Sanofi Pasteur Inc. 6/16 CODING for Vaccines and ToxoidsCoding for Immunization Administration: Component-based and Injection-based CodingAlthough vaccines are often administered at preventive-care visits, you can take advantage of the opportunity to administer vaccines at problem-focused, prescription re-fill, and screening visits, depending on your assessment of the current medical situation. Providers will usually be paid for immunizations administered at preventive and non-preventive visits, but plans which follow Correct CODING Initiative (CCI) edits may require that you use modifier -25 to be paid for the modifier -25 is attached to the CPT code for the office visit, and signals that it is separate and significant from other services provided at the same patient encounter.

10 Code the office visit, attaching an ICD-10 code that best describes the reason for the visit (the condition for which the patient presented or was treated), and modifier usual, code for the vaccine products and the immunization administration services using the appropriate CPT codes and the ICD-10 code(s) that identify the reason for real key here is to make sure that the office visit is paired with an ICD-10 code which describes the reason for the visit and that modifier -25 is attached. Also remember to always bill for immunization administration in addition to the product code, regardless of any other services billed on the of Modifier -25