Medical Billing and Coding Healthcare Blog

The American Medical Association has issued a new Current Procedural Terminology (CPT) code for influenza vaccine Flucelvax.

The code — CPT 90674 — went into effect on August 1, 2016, for Medicare claims. However, as the Centers for Medicare & Medicaid Services states, Medicare claims processing systems will not be able to accept the new code until January 1, 2017.

Until the start of the new year, you may hold claims containing CPT 90674. Alternatively, Medicare Administrative Contractors (MACs) may direct use of a Not Other Classified (NOC) code to allow billing for the vaccine for dates of service on or after August 1, 2016, and before January 1, 2017.

CMS advises providers to check with their MAC for this information and other interim billing instructions.

Note: If you bill institutional claims, CMS noted that code CPT 90674 will be implemented on February 20, 2017.

The Centers for Medicare & Medicaid Services (CMS) has issued a reminder to providers concerning billing the correct level of service for evaluation and management (E/M).

CMS notes that a 2012 study report from the Office of the Inspector General indicated that a number of physicians increased their billing of higher level, more complex and expensive E/M codes. Many providers submit claims coded at a higher or lower level than the medical record documentation supports.

CMS advises providers to use the following resources to assist in their efforts to bill correctly for E/M services: