Back to Flu Season

It’s that time of year again when school supplies are purchased and vaccines are updated. Influenza vaccines continue to challenge organizations to ensure each NDC, CVX code and HCPCS code are appropriately mapped in EMRs. We simplify this process with an Influenza Vaccine Billing Tool that can be found on our webpage Pharmacy Revenue Cycle | Visante.

Shout Outs!

1. Pharmacy and revenue integrity teams ensure the new NDCs are updated for accurate billing.
2. Pharmacy and revenue integrity teams revalidate Sanofi Pasteur’s high dose formulation at 0.7 mL versus the traditional 0.5 mL. CPT code 90662 will be used to code the high-dose formulation. Ensure the CDM or billing crosswalks reflect the updated 0.7 mL per billed unit or are based on a per dose and only one billed unit is calculated per dose.
3. Pharmacy and revenue integrity teams CPT 90686 and 90685 differ only by the dosage administered but often represent the same NDC. Validate that your system produces the correct CPT based on the dose administered and only one billed unit per dose. Applying a “dosing” rule that allows the CPT to alternate when a 0.25 mL vs. 0.5 mL dose is documented may be helpful.

Our goal is simple; we’re taking complex information and making it practical.
Until our next edition, this is Maxie Friemel and Agatha Nolen providing you with tips for increasing your Pharmacy Revenue Cycle.