Flu Shot Coding

Question: How do we code for an office visit with a flu shot and pneumonia shot? Do we need to use a modifier?

Answer: According to expert coder Emily Hill of Hill & Associates, the flu shot is reported with either 90656 or 90658 (over age 3) depending on whether or not it is preservative-free. G0008 is the administration code for Medicare. The administration code for other payers is 90471-90472, unless they have stated otherwise.

Use 90732 for the pneumococcal vaccine product. G0009 is the administration code for Medicare. 90471-90472 would be reported to other payers.

If you gave both shots to the same non-Medicare patient, you would bill the administration as 90471 and 90472 plus the vaccine products. 90471 is for the first vaccine and 90472 is an add-on code for each additional vaccine.

If you also provided a distinct E&M service unrelated to the vaccine, it would be reported separately. A modifier is not required.

For example: Non-Medicare patient: 90658, 90732, 90471, 90472, 99213; Medicare patient: 90658, 90732, G0008, G0009, 99213.