KY Department for Public KY Department for Public HealthHealth

2013-20142013-2014SEASON SEASON

INFLUENZA INFLUENZA for Local Health Departmentsfor Local Health Departments

ITV Training presented by: ITV Training presented by: Janet D. Overstreet (Local Health Operations Branch)Janet D. Overstreet (Local Health Operations Branch)

Cynthia H. Robinson, Coding Specialist (Local Health Operations Branch)Cynthia H. Robinson, Coding Specialist (Local Health Operations Branch)Jan Hatfield, RN , BSN, Influenza Coordinator (KY Vaccine Program)Jan Hatfield, RN , BSN, Influenza Coordinator (KY Vaccine Program)

August 28 , 2012 2:00-3:30pmAugust 28 , 2012 2:00-3:30pm

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This training is for KY Local Health Departments :

Providing seasonal influenza vaccinations andand reporting the vaccinations through the Patient Services Reporting System (PSRS)

--VFC received influenza vaccine, --VFC received influenza vaccine, or --Private purchased influenza vaccine--Private purchased influenza vaccine

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The Influenza Administration Record has the Vaccine Information Sheet (VIS) updates.

Assessing IncomeAssessing Income

• If the patient had income assessed in the past six (6) months, there is no requirement to re-assess the income.

• You will need to assureassure that if you change the income in the system, it does not pose issues for established patients who are participating in other LHD programs (i.e., WIC services, prenatal services, etc.)

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Collecting & Reporting Patient InformationCollecting & Reporting Patient Information

• REMINDER that it would be important to collect income information if:

•Self-Pay VFC eligible patients and charging the administration on the Sliding Fee•Other than VFC patients, if you provide flu vaccine and administration to patients and charging on a Sliding Fee

• If the patient does not complete the Household and Income fields, you may :

• Enter 1 - for “number in household” • Leave “annual income” field blank and enter “income assessed date” as the date of service (it will show on label as “N/A”); Income should default in the system at encounter entry to 100% pay

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Collecting & Reporting Patient InformationCollecting & Reporting Patient Information

Fixed-Full Charge (FFC):Fixed-Full Charge (FFC):

• May be used for self-pay patients for which your agency has self-pay patients for which your agency has purchased private stock vaccines purchased private stock vaccines and will be administering to the patient

• When flagged, the FFC rate will be assessed to the patient regardless of the amount of income listed for the patient

• Providing the influenza vaccination at a Fixed-Full Charge to the self-pay patient; the service is charged at the FFC rate set in the 501 Service File unless otherwise authorized by DPH.

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continued…

•FFC FFC may be used for reporting Self-Pay VFC eligible patients, however, they cannot be charged more than $19.93 $19.93 for the administration; DPH has approved an over-ride rate rounded to $19.00

•*”THE PROVIDER MAY IMPOSE A FEE FOR THE ADMINISTRATION OF A QUALIFIED PEDIATRIC VACCINE SO LONG AS THE FEE IN THE CASE OF A FEDERALLY-VACCINE ELIGIBLE CHILD DOES NOT EXCEED THE COSTS OF SUCH ADMINISTRATION (AS DETERMINED BY THE SECRETARY BASED ON ACTUAL REGIONAL COSTS FOR SUCH ADMINISTRATION).”

•*”THE PROVIDER WILL NOT DENY ADMINISTRATION OF A QUALIFIED PEDIATRIC VACCINE TO A VACCINE-ELIGIBLE CHILD DUE TO THE INABILITY OF THE CHILD'S PARENT TO PAY AN ADMINISTRATION FEE.”

*Source: http://www.cdc.gov/vaccines/programs/vfc/about/distribution.html

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Requests to Over-ride Flu RatesRequests to Over-ride Flu Rates

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If your LHD wants to request different rates for FLU vaccine administrationadministration than those in the PSRS system:

• Send your detailed request to the Local Health Operations (LHO) Branch at LocalHealth.HelpDesk@ky.gov

• RequesRequest for Influenza administrationadministration for self-pay patients: if your agency is billing MedicaidMedicaid for flu services, Medicaid billing rules will be considered in the approval process. (REMINDERREMINDER: VFC eligible patients cannot be charge more than $19.93 per immunization)

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INFLUENZA VACCINE private stock:INFLUENZA VACCINE private stock:

DPH will have listed in the 501 Service File the highest rate per CDC private sector dosehighest rate per CDC private sector dose;

LHDs may choose to over-ride privately purchased Influenza Vaccine Influenza Vaccine with a lesser ratelesser rate without written approval from DPH.

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Vaccine Coding and RatesVaccine Coding and Rates

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IF THE PATIENT ONLYONLY RECEIVES A FLU SHOT, an EEvaluation/MManagement visit CANNOTCANNOT be reported.

While receiving a flu shot, if the patient receives an an additional service requiring an E/Madditional service requiring an E/M reported for different diagnosis code; the problem-focused E/M code will need to be reported with a 25 modifier.

Example:Example: >19yr old patient presenting for family planning >19yr old patient presenting for family planning birth control supplies and gets a flu shot birth control supplies and gets a flu shot

W921225 (Office visit)W921225 (Office visit)90471 90471 oror G0008 (Vaccine administration) G0008 (Vaccine administration)90658 (Vaccine)90658 (Vaccine)

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Bottom half of the Seasonal Influenza Vaccine Administration Form.

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INFLUENZA (FLU) Vaccine Codes

CDPT Code (*non-KVP will require a NV modifier)

Description Rate (self pay) (501 Service File)

Medicare

Preventive Medicaid

(912 Service File)

Passport Health Plan (903 Service File)

Rev. 10/23/12, PHP eff. date 10/1/12

Note: Awaiting 2013 updates from Passport

90654* (not VFC covered)

Influenza, 18-64yrs, intradermal, preserv. free

17.00 (Slide and FFC)

18.38

18.40

(<19yrs) $18.40 ? (≥19yrs) 37.38 ?

90655* Influenza, 6-35mths, preservative free

15.25 (Slide and FFC)

16.45

18.40 18.40 ?

90656* Influenza, 3yrs and above, preservative free

14.00 (Slide and FFC)

12.39 18.40 (<19yrs) 18.40 ? (≥19yrs) 30.08 ?

90657* Influenza, 6-35mths

11.00 (Slide and FFC)

6.02

18.40 18.40 ?

90658* Influenza, 3yrs and above 12.00 (Slide and FFC)

18.40 (3yrs - <19yrs) 18.40 (19yrs - <65yrs) 29.77

90661* Influenza, preserv. & antibiotic free, 18 &above

18.25 Awaiting Medicare approval

18.40

90662* Influenza, preserv. free, high dose, enhanced

30.00 (Slide and FFC)

30.92

18.40

30.92 ?

90672* Influenza, live, intranasal, FluMist, 2yrs-49yrs

21.00 (Slide and FFC)

Awaiting Medicare approval

18.40 (<19yrs) 18.40 ? (≥ 19yrs) 41.86 ?

90673* Recombinant Influenza, 18-49yrs.

32.75

Awaiting Medicare approval

(not currently on Medicaid Prev.

sched)

90685* Influenza, Quad, 6-35 mths

15.25 Awaiting Medicare approval

18.40

90686* Influenza, Quad, 3 and above

15.25 Awaiting Medicare approval

18.40

BBeellooww MMEEDDIICCAARREE ccooddeess ((ffoorrmmeerrllyy 9900665588 ccooddee))

Q2033 Flublok-Influenza, 18-49yrs

14.00 (CDC private dose rate)

Q2035 Afluria- Influenza, 9yrs and ↑

11.54

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SEASONAL INFLUENZA CODES & RATES 2013 Seasonal Influenza Vaccine & Administration Rates listed on the following Services Files:

501 (Self-pay, Medicare & Insurance), 912 (Preventive Medicaid), 903 (Passport Health Plan)

Q2036 Flulaval- Influenza, 18yrs and ↑

9.83

Q2037 Fluvirin- Influenza, 4yrs and ↑

14.05

Q2038 Fluzone- Influenza, 3yrs and ↑

12.04

Q2039 NOS flu- Influenza, 3yrs and ↑

10.98 (CDC private dose rate)

INFLUENZA (FLU) Administration Codes

CDPT Code (non-VFC) Description Rate (self pay) (501 Service File)

Medicare

Preventive Medicaid

(912 Service File)

Passport Health Plan (903 Service File)

G0008

Flu Administration Medicare ≥19yrs <19yrs Not VFC

and Not by Component)

(Slide) 18.00 (FFC) 22.00

23.23 .

90471 (by injection) or 90473 (intranasal)

Flu Administration (6mos. - <19yrs) (VFC and Not by Component) Not VFC and by route

(Slide) 19.93

(FFC) 22.00

.

90460 (by Component)

Flu Administration (6mos. - <19yrs) VFC and by Component Not VFC and by Component

(Slide) 19.93

(Slide at 19.93) or (FFC at 22.00)

•

When reporting the G0008 administration codeG0008 administration code, the 80000 pseudo procedure code should not should not be needed. be needed.

When reporting the 9046090460, 9047190471 or 90473 vaccine 90473 vaccine administration codesadministration codes, the 80000 will will be needed.

If billing Medicare or insurances, use the administration codes required by those third parties.

When coding by component When coding by component you should review the VIS form thoroughly with the patient/parent/legal representative, discuss the risk, benefits and side effects andand document document that you counseled per component.

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Influenza Vaccine for 2013-2014• VIS updated for this flu season

– Universal vaccination beginning at 6 mos. (same as last year)

• Trivalent vs. Quadrivalent Vaccine– Trivalent contains two A viruses and one B virus that

was the predominate strains for last year– Quadrivalent will contain the same three strains

above in addition to an additional B virus– Vaccine availability will be predominately Trivalent

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CCSG Influenza Protocols

• Changes– New Abbreviations

• IIV3 (Inactivated Influenza Vaccine, Trivalent)• IIV4 (Inactivated Influenza Vaccine, Quadrivalent)• LAIV4 (Live-Attenuated Influenza Vaccine,

Quadrivalent)– Flumist® - Nasal Sprayer 2 to 49 yrs.

• Protocols for administration will be the same for Trivalent and Quadrivalent vaccines

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Helpful web-links:

• http://www.flu.gov/#

• http://www.cdc.gov/flu/

• http://www.cdc.gov/flu/professionals/index.htm

• http://www.cdc.gov/flu/freeresources/index.htm

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Contact Information

Jan Hatfield, RN, BSNInfluenza CoordinatorInfluenza Coordinator502-564-4478 x4273Jan.Hatfield@ky.gov

Local Health Operations (LHO) Branch502-564-6663, Option 1Option 1

LocalHealth.HelpDesk@ky.gov

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Questions Questions

Thank YouThank You

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