The Centers for Disease Control and Prevention (CDC) held a Morbidity and Mortality Weekly Report (MMWR) telebriefing July 19 on pertussis, or whooping cough, and the epidemic that’s occurring in Washington state. According to Dr. Anne Schuchat, director for the National Center for Immunization and Respiratory Diseases at CDC, Washington state is not alone in its plight. “What is happening in Washington state is a reflection of the larger national picture. … We’re seeing a substantial increase in pertussis cases in the United States and in individual states like Washington,” Schuchat said.
Washington state has had 2,520 cases of pertussis this year as of June 16, but the number of cases reported nationwide is even more concerning. “As of today, nationwide, nearly 18,000 cases have been reported to CDC,” Schuchat said. “That’s more than twice as many as we had at the same time last year. In fact, it’s more than we had in each of the past five years. We may be on track for record high pertussis rates this year. We may need to go back to 1959 to find a year with as many cases reported by this time so far. So, there is a lot of pertussis out there and I think there may be more coming to a place near you.”
Pertussis is most dangerous for babies and very young children. Early symptoms can include runny nose, low-grade fever, and mild, occasional cough—similar to that of a cold. Infants may experience apnea (a pause in breathing). As the disease progresses, the coughing becomes more persistent and might create a “whooping” sound. Relentless coughing fits that can come and go for weeks on end cause exhaustion, which compromises immunity.
Young children aren’t the only ones at risk, however. Schuchat said, “We’re also seeing high rates … among children 10 years of age. By age 10, immunity can wane from the early-childhood vaccines that kids get.” The CDC is also seeing an increase nationally in the 13-to-14 year age group. “The increased number of cases among 13-to-14 year olds is a concern we are looking at in detail,” Schuchat said.
Pertussis vaccine remains the single most effective approach to prevent infection. The CDC continues to recommend that all children and adults get fully vaccinated to prevent infection and to protect infants.
Adolescents 11-18 years of age (preferably at age 11-12 years) and adults 19 through 64 years of age, as well as adults 65 and older who have close contact with an infant and have not previously been vaccinated, should receive a single dose of Tdap. Tdap should also be given to 7-10 year olds who are not fully immunized against pertussis. Children should get five doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months, and 4-6 years.
Pertussis is generally treated with antibiotics and early treatment is very important. The CDC is asking clinicians who see patients with a persistent cough or who may have been exposed to the disease to consider pertussis as a diagnosis (ICD-9-CM 033.9 Whooping cough, unspecified organism).
“Be proactive with treatment, especially with pregnant women, infants, and others who are around infants,” urged Schuchat.
July 26th, 2012
The American Medical Association (AMA) released a host of mid-term CPT® code updates July 1. Among the new releases are vaccine codes for 2013 and 2014, and a number of Category II and III codes. In addition to reorganization of codes in Category III, 16 codes have been added or changed in the first two categories.
Category I Vaccine Codes
To facilitate immunization reporting, the AMA has released the vaccine codes for reporting beginning Jan. 1 2013. There are several new and revised codes, and a few codes that were recently approved by the U.S. Food and Drug Administration (FDA).
Following FDA approval status, the AMA has removed the “FDA approval pending” indicator from CPT® code 90644 Meningococcal conjugate vaccine, serogroups C & Y and Hemophilus influenza B vaccine (Hib-MenCY), 4 dose schedule, when administered to children 2-15 months of age, for intramuscular use. Please note this change in your 2012 CPT® codebook.
Making its debut in the 2013 CPT® codebook is 90653 Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use. This new code was released July 1 and will be implemented Jan. 1, 2013 with an “FDA approval pending” indicator.
The following codes are being revised for CPT® 2013 to include the term “trivalent,” which means the vaccine provides immunity to three different pathogenic strains of flu:
90655 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
90656 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals 3 years and older, for intramuscular use
90657 Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
90658 Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use
90660 Influenza virus vaccine, trivalent, live, for intranasal use
The following two new codes will appear in the 2013 CPT® codebook:
90739 Hepatitis B vaccine, adjust dosage (2 dose schedule), for intramuscular use (this code will have an “FDA approval pending” indicator)
90672 Influenza virus vaccine, quadrivalent, live, for intranasal use
Also for CPT® 2013, look for a revision to the descriptor for existing code 90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use.
Lastly, the following four new codes were accepted at the May 2012 CPT® Editorial Panel meeting for the 2014 CPT® codebook production cycle (with “FDA approval pending” indicators):
90685 Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use
90686 Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use
90687 Influenza virus vaccine, quadrivalent, split virus, when administered to children 6-35 months of age, for intramuscular use
90688 Influenza virus vaccine, quadrivalent, split virus, when administered to individuals 3 years of age and older, for intramuscular use
You can download the CPT® Category I Vaccine Codes document from the AMA website.
Category II Codes Update
Category II codes are supplemental tracking codes that can be used for performance measurement. Their use is optional. The AMA has added, deleted, or reinstated several of these codes in the Patient Management (0500F-0584F), Patient History (1000F-1505F), Diagnostic/Screening Processes or Results (3006F-3763F), and Therapeutic, Preventive or Other Interventions (4000F-4563F) sections.
The release date for these codes varies; and some will appear in CPT® 2013 and others not until CPT® 2014.
Download the complete list of Category II code changes from the AMA website.
Category III Codes Update
The AMA is adding a number of Category III temporary codes that describe emerging technology, services, and procedures, some of which will appear in CPT® 2013 and others in CPT® 2014. Category III codes 0291T-0301T, for example, will make their debut in the 2013 CPT® codebook, but were effective Jan. 1, 2012. The same holds true for revised code 0206T Computerized database analysis of multiple cycles of digitized cardiac electrical data from two or more ECG leads, including transmission to a remote center, application of multiple nonlinear mathematical transformations, with coronary artery obstruction severity assessment and codes 0302T-0308T. Whereas, Category III codes 0319T-0328T, accepted at the May 2012 CPT® Editorial Panel meeting, will be effective Jan. 1, 2013, but will not appear in the CPT® codebook until 2014.
For a complete list of new CPT® Category III codes, download the AMA document.
Note: As per the AMA, “Start dates may vary from payer to payer and may differ from the AMA implementation dates. Therefore, check with the payer for specific payer information regarding use of these codes as part of any program.”
July 13th, 2012
UnitedHealthcare has expanded its coverage of Gardasil®. Effective Feb. 1, 2012, the insurer will cover the HPV4 vaccine for both females and males aged 9-26 years, according to UnitedHealthcare’s March 2012 Network Bulletin.
This coverage is based on new recommendations made by the Advisory Committee on Immunization Practices (ACIP) in October 2011 for Human Papillomavirus Quadrivalent (Types 6, 11, 18, and 18) Vaccine, Recombinant (Gardasil).
Human papilloma virus (HPV) can cause cervical, vaginal, and vulvar cancers in females, and genital warts in both males and females, according to Merck & Co., Inc.—the manufacturer of Gardasil.
Merck says the commonly used codes below may apply to private payer reimbursement for vaccination with Gardasil:
| CPT® |
Descriptor |
| 90649 |
Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use |
| 90471 |
Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) |
| ICD-9-CM |
Descriptor |
| V04.89 |
Need for prophylactic vaccination and inoculation against other viral diseases |
| V05.8 |
Need for prophylactic vaccination and inoculation against other specified disease |
March 16th, 2012
Effective for claims processed with dates of service on or after Jan. 1, 2011, Outpatient Prospective Payment System (OPPS) providers should report HCPCS Level II code G0010 Administration of hepatitis b vaccine for the administration of hepatitis b vaccine, rather than CPT® 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) or 90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).
This policy has been in effect since Jan. 1, 2011, but the Medicare Claims Processing Manual was not updated at chapter 18, section 10.2.1 to reflect the correct billing instructions.
Claims processed incorrectly prior to July 2, 2012 should be brought to the attention of your contractor on or after July 2, 2012 for adjustment.
Source: MLN Matters® MM7692, issued Jan. 25, 2012.
February 10th, 2012