Diabetes Coding

Frances J. Hood, MLS, RHIA


South Med J. 2002;95(1) 

In This Article

Medicare Influenza/Pneumococcal Vaccination Benefits Coverage

People with diabetes are about three times as likely to die with flu and pneumonia than people without diabetes. During flu epidemics, diabetic patients are six times as likely to go to the hospital.[4] Diabetic patients should receive a pneumococcal vaccine (PPV) and an annual flu shot. Influenza vaccines are typically administered once a year. PPV vaccines are typically administered once in a lifetime to persons at high risk of pneumonia infection. Medicare no longer requires that a doctor of medicine or osteopathy orders the vaccines for either flu or PPV coverage purposes.

Medicare Part B began paying for influenza virus vaccines in 1998 and PPV in 1981. Coverage of the vaccines and their administration is available only under Medicare Part B regardless of the setting in which they are furnished. Medicare beneficiaries who get the vaccines do not pay the usual coinsurance or deductible amounts. Medicare pays those amounts, along with an amount for the vaccine and an additional amount for administering the shot.

If a physician sees a patient for the sole purpose of administering a flu or PPV vaccination, the physician may bill only for the administration and vaccine. However, if a patient actually receives reasonable and medically necessary services constituting an "office visit" level of service, the physician may bill for the visit, the vaccine, and the administration of the vaccine. The following diagnosis codes are appropriate for use when billing Medicare patients for flu and/or PPV:

  • Influenza virus vaccine is billed using diagnosis code V04.8

  • PPVis billed using diagnosis code V03.82.

One of the following procedure codes is appropriate for use when billing Medicare patients for influenza virus vaccine (the codes are not interchangeable):

  • 90657 Influenza virus vaccine, split virus, 6-35 months' dosage, for intramuscular or jet injection use

  • 90658 Influenza virus vaccine, split virus, 3 years and above, for intramuscular or jet injection use

  • 90659 Influenza virus vaccine, whole virus, for intramuscular or jet injection use.

The appropriate CPTcode used to bill Medicare patients for PPV vaccination is:

  • 90732 Pneumococcal polysaccharide vaccine, 23-valent, adult dosage, for subcutaneous or intramuscular use.

The previously mentioned CPTcodes are for vaccine only and do not include administration. The appropriate HCPCS code to use for administration of the vaccination is:

  • G0008 Adminstration of influenza virus vaccine

  • G0009 Administration of pneumococcal vaccine.[3]

(For the latest ICD-9-CM coding guidelines, refer to the following website: http://www.cdc.gov/nchs/datawh/ftpserv/ftpicd9/ftpicd9.htm#guide)

We trained hard, but it seems every time we were beginning to form into teams, we would be re-organized. I was to learn later in life that we tend to meet every new situation by re-organizing and a wonderful method it can be for creating the illusion of progress while producing confusion, inefficiency and demoralization. -- Petronius, 1 AD


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