Typically, vaccines require years of research, testing, and evaluation before it makes it to the clinical trials. However, in 2020, the researchers and scientists were up against the race of time, embarking on the expedition of saving human lives through the earliest breakthrough possible. Currently, there are at least 78 vaccines under clinical trials.
The global endeavor to produce the safe-to-use and effective vaccine for COVID19 is successful. With dozens of vaccines authorized, a handful remains in the development phase. Where the development of vaccines brings the good news of the possible end of the pandemic, it has its own challenges for healthcare organizations. Now that the vaccines are being shipped and sent across the globe to combat the endemic, billing and coding strategies are now the major concern.
Since these vaccines and dosages are sent for free, the drug providers cannot charge the patient for their usage. To make sure the payments are made correctly and the medical office compensated, the providers will have to submit claims for vaccine administration and purchases. The governments are targeting to ship as many vaccines as possible across the country once the FDA approves of them for emergency use.
Is the Vaccine Safe?
The vaccine has gone through extensive testing and safety assurance trials for effectiveness. The Food and Drug Administration has determined rigorous quality standards for the vaccine to ensure safe usage. The conflicting information about the vaccine is causing significant concerns among the doctors. The FDA hasn’t approved any vaccine, and three of the vaccines were only authorized for emergency use. The mRNA vaccines from Moderna and Pfizer were authorized with EUA in December 2020. The third vaccine, Janssen, was given the EUA in February 2021. All three vaccines are proven to be effective in COVID prevention, disease hospitalizations, and death.
None of these vaccines have reported any major safety concerns. It is recommended to get vaccinated as per the released eligibility criteria. The CDC has come up with a smart technological tool to monitor the effect of the vaccine. The V-safe mobile-based application has text messaging and web surveys to offer personalized vaccine monitoring. It even allows the recipient to notify the CDC and healthcare provider about the possible side effect of the vaccine.
The Types of Codes Released for Vaccine
These new codes and strategies were added because of the pandemic outbreak and deals with virus-specific immunization. Healthcare organizations and drug providers adopt these codes to account for the reports of coronavirus.
CPT:
The Current Procedural Terminology (CPT) has released the new and updated set of codes to report immunization of the virus. These codes help in better differentiation of the vaccine, allowing for improved tracking, reporting, and evaluation. The data-driven analysis and allocation ease up the updating of electronic systems across the healthcare organizations and sector. At present, two vaccines are shipped for vaccination purposes: Pfizer-BioNTech and a drug by Moderna. The assigned codes for both the drugs are as follows:
- Pfizer-BioNTech: Category I code 91300
- Moderna: Code 91301
The CPT has also created vaccine-specific codes to administer and distinguish the dosage of each vaccine.
ICD:
The International Classification of Diseases (ICD) is developed, updated, and released by WHO. These codes are employed for virus detection, the introduction of therapeutics, and documentation of antibodies. The new ICD-10 codes are as follows:
- U07.1 COVID-19 for virus identification
- U07.2 COVID-19 for no virus detection.
Both these classifications can be used for death coding. In a similar way, ICD-11 records both the coding health and cause of death. The ICD-11 will be employed as an official reporting standard in January 2022, replacing the ICD-10 as a healthcare disease reporting standard.
The dosage is to be billed for the vaccine administration only. The vaccine codes are not to be mentioned on claim forms for the free vaccine. Effective billing not only guarantees complete reimbursement but eases the reporting process as well. The CMS has released the updated payment and code structure for complete vaccine information and administration purposes. Make sure to review the fact sheet by FDA for Pfizer-BioNTech to review the limitation of the vaccine before usage.
For more information please click the link:
https://www.cms.gov/medicare/covid-19/coding-covid-19-vaccine-shots