Medicare Vaccinations for Medical Coders

We had a question come in specifically about a Medicare patient.
Q: “A Medicare patient is seen by the nurse for a pneumonia vaccination (PCV13). The nurse administers the pneumonia vaccine in the right deltoid. The physician reviews the chart and signs off on the nurse’s note.
A. 90471, 90670, Z23
B. G009, 90670, Z23
A: We want to go over some of the facts about Medicare patients first, immunizations that Medicare patients can receive. They do cover their Part B benefits, you’re not using their Part D for prescription, this is all under Medicare Part B benefits that will cover seasonal influenza vaccinations as well as pneumonia vaccinations and the administration to give those vaccinations. Is the patient responsible for them, or is it covered for the patient? Actually the patient is not susceptible to their copays or deductibles for those vaccinations, it’s part of one of the benefits that Medicare allows for the preventive care for patients, is they don’t have them pay their deductible or the copay. So, it’s definitely a benefit for these patients to go see their primary care doctor and get these shots each year.
How often, looking at the pneumonia vaccine, how often can that be given? You get your initial vaccine billed to the Medicare system, then you can get it 11 months from that first one, so about every year they’re allowed to come in. That is one of those that you need to check the timing off so definitely need to watch for if a patient is coming from through transient, they’re coming from another area, they’ve just moved or their primary care is no longer a business, they’re coming to a new primary care office now. That’s one of those things that you need to track these vaccines carefully.
If you have one of these patients who is transient or you don’t know and they can’t recall when their last vaccine was, definitely get them to sign an ABN or a waiver that this may not be covered, so we’re not sure and once we bill it, Medicare will let us know.
Can they have all of all these vaccines on one day or do you have to make them come back? You can actually bill these vaccines all in one day so you can give them their influenza vaccine as well as the pneumonia vaccine on the same day. They will pay for both the administration fees if they get them both on the same day, so that is a service as well to the patient being able to provide them all at one time.
So, our answer is actually B, we’re going to use the HCPCS code. Actually, this chart comes directly off of the Medicare’s preventive care website and that is a very, very useful tool. Definitely check that out if you work in the primary care office or a family practice internal medicine, anything that uses these codes quite often especially for the preventive services for Medicare patients, but their admin code is the G0009, their diagnosis should be that Z23 and you’re using the 90670 code for the vaccine, and the administration is your G code, not the administration of a CPT code.
I think I did get the link at the bottom as well. Yup! This link here this tells you all of the 28 services that Medicare patients can have for their mammographies, their colonoscopies, all the services that they might provide that they consider preventive care gives you all the codes you need, the diagnosis that should be used, as well as how often this patients can receive these services. So, it’s definitely a good site if it’s something that you’re doing all the time.
Coach Alicia: Excellent. You guys need to just have cms.gov bookmarked because… [Laughs]
Boyd: Thanks, Jennifer, that was cool.