1. KY Department for Public Health 2013-2014 SEASON INFLUENZA for Local Health Departments ITV Training presented by: Janet D. Overstreet (Local Health Operations Branch) Cynthia H. Robinson, Coding Specialist (Local Health Operations Branch) Jan Hatfield, RN, BSN, Influenza Coordinator (KY Vaccine Program) August 28, 2012 2:00-3:30pm 1

2. and --VFC received influenza vaccine, --Private purchased influenza vaccine This training is for KY Local Health Departments : Providing seasonal influenza vaccinations and reporting the vaccinations through the Patient Services Reporting System (PSRS) --VFC received influenza vaccine, or --Private purchased influenza vaccine 2

3. 3 The Influenza Administration Record has the Vaccine Information Sheet (VIS) updates.

4. Assessing Income If the patient had income assessed in the past six (6) months, there is no requirement to re-assess the income. assure You will need to assure that if you change the income in the system, it does not pose issues for established patients who are participating in other LHD programs (i.e., WIC services, prenatal services, etc.) 4

5. Collecting & Reporting Patient Information REMINDER that it would be important to collect income information if: Self-Pay VFC eligible patients and charging the administration on the Sliding Fee Other than VFC patients, if you provide flu vaccine and administration to patients and charging on a Sliding Fee If the patient does not complete the Household and Income fields, you may : Enter 1 - for number in household Leave annual income field blank and enter income assessed date as the date of service (it will show on label as N/A); Income should default in the system at encounter entry to 100% pay 5

6. Collecting & Reporting Patient Information Fixed-Full Charge (FFC): self-pay patients for which your agency has purchased private stock vaccines May be used for self-pay patients for which your agency has purchased private stock vaccines and will be administering to the patient When flagged, the FFC rate will be assessed to the patient regardless of the amount of income listed for the patient Providing the influenza vaccination at a Fixed-Full Charge to the self-pay patient; the service is charged at the FFC rate set in the 501 Service File unless otherwise authorized by DPH. 6

7. continued… FFC $19.93 FFC may be used for reporting Self-Pay VFC eligible patients, however, they cannot be charged more than $19.93 for the administration; DPH has approved an over-ride rate rounded to $19.00 * THE PROVIDER MAY IMPOSE A FEE FOR THE ADMINISTRATION OF A QUALIFIED PEDIATRIC VACCINE SO LONG AS THE FEE IN THE CASE OF A FEDERALLY-VACCINE ELIGIBLE CHILD DOES NOT EXCEED THE COSTS OF SUCH ADMINISTRATION (AS DETERMINED BY THE SECRETARY BASED ON ACTUAL REGIONAL COSTS FOR SUCH ADMINISTRATION). * THE PROVIDER WILL NOT DENY ADMINISTRATION OF A QUALIFIED PEDIATRIC VACCINE TO A VACCINE- ELIGIBLE CHILD DUE TO THE INABILITY OF THE CHILD'S PARENT TO PAY AN ADMINISTRATION FEE. *Source: http://www.cdc.gov/vaccines/programs/vfc/about/distribution.htmlhttp://www.cdc.gov/vaccines/programs/vfc/about/distribution.html 7

8. Requests to Over-ride Flu Rates 8

9. administration If your LHD wants to request different rates for FLU vaccine administration than those in the PSRS system: Send your detailed request to the Local Health Operations (LHO) Branch at LocalHealth.HelpDesk@ky.gov LocalHealth.HelpDesk@ky.gov Requesadministration Medicaid Request for Influenza administration for self-pay patients: if your agency is billing Medicaid for flu services, Medicaid billing rules will be considered in the approval process. REMINDER (REMINDER: VFC eligible patients cannot be charge more than $19.93 per immunization) 9

10. INFLUENZA VACCINE private stock: highest rate per CDC private sector dose Influenza Vaccine lesser rate INFLUENZA VACCINE private stock: DPH will have listed in the 501 Service File the highest rate per CDC private sector dose; LHDs may choose to over-ride privately purchased Influenza Vaccine with a lesser rate without written approval from DPH. 10

11. Vaccine Coding and Rates 11

12. ONLY EMCANNOT an additional service requiring an E/M Example: >19yr old patient presenting for family planning birth control supplies and gets a flu shot W921225 (Office visit) 90471 or G0008 (Vaccine administration) 90658 (Vaccine) IF THE PATIENT ONLY RECEIVES A FLU SHOT, an Evaluation/Management visit CANNOT be reported. While receiving a flu shot, if the patient receives an additional service requiring an E/M reported for different diagnosis code; the problem-focused E/M code will need to be reported with a 25 modifier. Example: >19yr old patient presenting for family planning birth control supplies and gets a flu shot W921225 (Office visit) 90471 or G0008 (Vaccine administration) 90658 (Vaccine) 12

13. 13 Bottom half of the Seasonal Influenza Vaccine Administration Form.

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16. G0008 administration code should not be needed. 904609047190473 vaccine administration codeswill When coding by component and document When reporting the G0008 administration code, the 80000 pseudo procedure code should not be needed. When reporting the 90460, 90471 or 90473 vaccine administration codes, the 80000 will be needed. If billing Medicare or insurances, use the administration codes required by those third parties. When coding by component you should review the VIS form thoroughly with the patient/parent/legal representative, discuss the risk, benefits and side effects and document that you counseled per component. 16

17. Influenza Vaccine for 2013-2014 VIS updated for this flu season – Universal vaccination beginning at 6 mos. (same as last year) Trivalent vs. Quadrivalent Vaccine – Trivalent contains two A viruses and one B virus that was the predominate strains for last year – Quadrivalent will contain the same three strains above in addition to an additional B virus – Vaccine availability will be predominately Trivalent 17

18. CCSG Influenza Protocols Changes – New Abbreviations IIV3 (Inactivated Influenza Vaccine, Trivalent) IIV4 (Inactivated Influenza Vaccine, Quadrivalent) LAIV4 (Live-Attenuated Influenza Vaccine, Quadrivalent) – Flumist® - Nasal Sprayer 2 to 49 yrs. Protocols for administration will be the same for Trivalent and Quadrivalent vaccines 18

19. Helpful web-links: http://www.flu.gov/# http://www.cdc.gov/flu/ http://www.cdc.gov/flu/professionals/index.htm http://www.cdc.gov/flu/freeresources/index.htm 19

20. Contact Information Jan Hatfield, RN, BSN Influenza Coordinator 502-564-4478 x4273 Jan.Hatfield@ky.gov Local Health Operations (LHO) Branch Option 1 502-564-6663, Option 1 LocalHealth.HelpDesk@ky.gov 20

21. Questions Thank You 21