Coding Consult

January 20, 2006

Answers to your questions about . . .

Multiple nebulizer treatments

A You'll need to use a modifier. When a patient receives multiple aerosol treatments on the same date, you should use 94640 (pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes [e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device]) for the first treatment. Subsequent treatments will require modifier –76 (repeat procedure by same physician). You'd code 94640 for the first treatment and 94640–76 x 2 for the two subsequent treatments.

Vaccine administration

Q I submit 90658 when a nurse gives a patient a flu shot. Should I also report an administration fee?

A Absolutely. Code 90658 (influenza virus vaccine, split virus, for use in individuals 3 years of age and above, for intramuscular use) represents the vaccine product only. The code's relative value units don't include the cost of the injection supplies and staff services. You should capture these costs with the appropriate administration code.

The administration code depends on the insurer. When you submit an influenza vaccination claim to a Medicare carrier, report G0008 (administration of influenza virus vaccine when no physician fee schedule service on the same day). For patients with private insurance, use 90471 (immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]).

Link both the administration code (90471 or G0008) and the vaccine product code (90658) to V04.81 (need for prophylactic vaccination and inoculation against certain viral diseases; influenza).

If the patient receives additional vaccinations, such as a pneumonia shot, on the same day, report a separate administration service. For Medicare, use G0009 (administration of pneumococcal vaccine when no physician fee schedule service on the same day). For private payers, submit +90472 (. . . each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]).

So you'd report the pneumonia vaccine product with 90732 (pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use). Then link G0009/90472 and 90732 to V03.82 (other specified vaccinations against single bacterial diseases; Streptococcus pneumoniae [pneumococcus]).

This information is adapted from material provided by the Coding Institute. For a free sample issue or information on how to subscribe to any of 29 specialty-specific coding newsletters, please contact the Coding Institute, 2272 Airport Road South, Naples FL 34112; phone 800-508-2582; fax 800-508-2592 or visit