| Uncircled vaccines, administrations could cost your | | | | Hib at her 15-month preventive medicine service. The |
| practice dear. You thought increasing payments this | | | | check-out attendant would circle: |
| year is a fairy tale? Well, your magic wand is right at | | | | For vaccine products: |
| your front desk. "Check-out coding can have a | | | | • 90707 - Measles, mumps, and rubella virus |
| noteworthy financial impact,"reported Norman | | | | vaccine (MMR), live, for subcutaneous use • |
| "Chip"Harbaugh, MD, in "Vaccine Reimbursement — | | | | 90700 — Diphtheria, tetanus toxoids, and acellular |
| Quite a Quandary"at The Coding Institute's | | | | pertussis vaccine (DTaP), when administered to |
| December 2010 Pediatric Coding and Reimbursement | | | | individuals younger than seven years, for |
| Conference in Orlando. Not having the check-out | | | | intramuscular use 90648 — Hemophilus influenza b |
| person ensure the pediatrician circles all performed | | | | vaccine (Hib), PRPT conjugate (4 dose schedule), for |
| services and procedures can cost a practice with | | | | intramuscular use. • For three shots with physician |
| median collections of $556,000 between 2.2 percent | | | | counseling provided to a child below eight years of |
| to 10.2 percent or $12,340 to $57,000. | | | | age: • 90465 — Immunization administration |
| To plug those payment holes, train your front desk | | | | younger than eight years of age (includes |
| staff to find two signs of overlooked coding | | | | percutaneous, intradermal, subcutaneous, or |
| opportunities. | | | | intramuscular injections) when the doctor counsels |
| #1:Verify 90476-90749, 90465-90474 on crying | | | | the patient/family; first injection (single or combination |
| departees | | | | vaccine/toxoid), per day (0.58 relative value units |
| If you have a kid age two or younger who comes | | | | [RVUs]) • +90466 — … each additional |
| to the check-out window crying, there is a good | | | | injection (single or combination vaccine/toxoid), per |
| opportunity he has just got his required shots. The | | | | day (List separately in addition to code for primary |
| pediatrician may have circled the apt preventive | | | | procedure) (0.29 RVUs) • +90466. Savings: |
| medicine service code – 99381 (Initial | | | | Catching the vaccines and immunization |
| comprehensive preventive medicine E&M of an | | | | administrations saves the practice around $224. |
| individual … infant [age younger than 1 year]) or | | | | Missing the administrations alone costs you |
| 99382 (… early childhood [age 1 through 4 years]) | | | | approximately $42 utilizing the 2009 Medicare |
| for new patients or 99391 (Periodic comprehensive | | | | Physician Fee Schedule and conversion factor (CF) of |
| preventive medicine reevaluation and management of | | | | 36.0666. The breakdown includes $20.92 for the initial |
| an individual … infant [age younger than 1 year]) or | | | | administration and $10.46 for each of the two |
| 99392 (… early childhood [age 1 through 4 years]) | | | | subsequent administrations. Coupled with losses of |
| for established patients. However, she may have | | | | $107.25 for the vaccine products (based on average |
| forgotten to code the vaccines (90476-90749, | | | | payments) and $74.28 in capital vaccine investment |
| Vaccines, Toxoids) or the administrations | | | | using Harbaugh's calculations, you'd have had a total |
| (90465-+90474, Immunization Administration for | | | | loss of $223.53. Let your ears alert you to injections |
| Vaccines, Toxoids). "Our medical coder has been | | | | Eavesdropping may not be rigueur, however you can |
| reporting only the vaccines without the | | | | use overheard conversations to catch missed |
| administration,"one physician conference attendee | | | | services. According to Richard Lander, MD, FAAP, |
| reported. | | | | pediatrician with Essex-Morris Pediatric Group in |
| Here's a tip: "The more eyes you have watching the | | | | Livingston, N.J, "In the ideal (prepayment) coding |
| charge ticket and entry, it's more likely you are to | | | | process, the doctor checks off the code and |
| avoid missed codes,"points out Harbaugh. On a less | | | | diagnosis on the superbill and the staff reviews it and |
| than two years of well visit check-out in which the | | | | catches any errors." Let us say a pediatrician |
| toddler is crying, you can train your check-out staff | | | | evaluates a patient for croup and the check-out staff |
| to query, "How'd the vaccines go"? | | | | heard the physician tell the nurse to provide the |
| Say for instance the mother responds, "No, Suzie did | | | | patient a Decadron shot. The pediatrician did not |
| not receive any vaccines."The checkout person | | | | mark ‘injection' on the charge ticket. The |
| knows, "OK, 99381, 99382, 99391 or 99392 as the | | | | checkout person checks with the nurse who concurs |
| only CPT code is right,"Harbaugh, a primary care | | | | that the patient received a shot, and the staff then |
| pediatrician practicing in Atlanta explains. | | | | codes the: • injection administration with 96372 |
| Let's say the mother responds, "No, Suzie didn't | | | | (Therapeutic,prophylactic, or diagnostic injection |
| receive any vaccines."The checkout person knows, | | | | (specify substance or drug); subcutaneous or |
| "OK, 99381, 99382, 99391, or 99392 as the only CPT | | | | intramuscular) • drug supply with J1100 (Injection, |
| code is right,"explains Harbaugh, a primary care | | | | dexamethasone sodium phosphate, 1 mg). Savings: |
| pediatrician practicing in Atlanta. | | | | According to the 2009 Medicare Physician Fee |
| If the mother says, "Three at one go is very | | | | Schedule, which uses a national conversion factor of |
| hard,"the check-out person can check with the nurse | | | | 36.0666, catching that the patient received an |
| or medical technician to find out which vaccines the | | | | injection adds a deserved 0.58 relative value units or |
| patient received. On the charge ticket, the check-out | | | | approximately $21 to the claim. Most payers take up |
| person can then add the right administration and | | | | this resource-based relative value system in some |
| vaccine codes." | | | | fashion. The Medicare payment limit for J1100 is $0.09. |
| For instance, say the child received MMR, DTaP, and | | | | |