H1N1 Vaccines and Partner

Some pediatric offices are holding H1N1 flu clinics or administering H1N1 vaccines by appointment. There are four different H1N1 vaccines and special dosage requirements depending on patient age. You can use Partner tools to simplify your administering and tracking of H1N1 vaccine distribution.

The sections below detail the different H1N1 vaccines available in the United States and PCC’s “best practices” recommendations for tracking H1N1 vaccines in Partner.

For information about flu clinic configuration, Flu Clinics with Partner

What H1N1 Vaccines Are Available?

There are four H1N1 vaccines available in the U.S.:

• Intramuscular for 18+, by CSL Limited
• Intramuscular for 4+, by Novartis
• Intramuscular for 6mo+, by Sanofi Pasteur
• Nasal for 2yr to 49yr, by MedImmune LLC

You can read complete details about each of these vaccines at the FDA’s Guide to Approved H1N1 Vaccines site.

What are the Dosage Requirements?

A single vaccine administration, of any of the four vaccines, is sufficient for patients 10 years and older.

Patients under 10 years old require a follow-up vaccine at least 21 days after the first vaccine, though the CDC recommends a full four-week gap between the initial dose and the secondary dose.

How Should I Add the Vaccines to the Partner System?

PCC recommends that you add each of your office’s vaccines to your Partner tables separately. We also recommend that you add vaccines that you give to patients under 10 years old twice, once for each shot, in order to simplify tracking.

Example: If your office used both the Sanofi 6mo+ injectable vaccine and the MedImmune nasal vaccine, you might add the following five entries to your Procedures table in the Table Editor (ted):

• H1N1 First Dose, Intramuscular (90663)
• H1N1 Second Dose, Intramuscular (90663)
• H1N1 First Dose, Nasal (90663)
• H1N1 Second Dose, Nasal (90663)
• H1N1 Immunization Administration (90470)

When posting the charges in checkout, be sure and select the correct immunization and the correct dose, and then select the administration code. PCC can help you configure both your encounter forms and your charge screens to simplify this process.

If you create multiple table entries as recommended, you can later use any procedure-based report in Partner (such as ira or those found in SRS) to detail how many doses of each shot you administered. If your state requires you to submit total numbers of each vaccine given, you will not have to review your records by hand.

Special Coding Circumstances

The 90663 pandemic code is appropriate for any of the four H1N1 vaccines. For Medicare, use G9142 for the vaccine procedure and G9141 for administration. Some states may require the Medicare codes for Medicaid, as well, so check the requirements in your area.

Some carriers may require a -SL modifier on the 90663/G9142 codes. You can set up alternative code schedules for procedures in the Table Editor (ted). Contact PCC Support for assistance.

How Should I Notify Patients About the H1N1 Vaccine?

Your office may choose to notify and recall all of your patients, all of your patients of a certain age range, or only patients who have had certain high-risk diagnoses or who have received flu shots at your practice before.

Run the Patient Recaller (recaller) and select the criteria you wish to recall.

Note: Practices frequently use the “last appointment date” criteria in recaller to limit the list of patients to those who have visited within the last three years.

How Can I Make Sure That Kids Under 10 Get Their Second Shot?

You can also use recaller to track and contact the families of younger patients so they come in for their second dose.

Run the Patient Recaller and select the age range criteria and both the include and exclude procedure criteria.

Note: You can also exclude by appointment date, to leave patients with scheduled follow-up appointments off the list.

On the criteria detail screens, enter a birthdate range for patients under 10, include by patients who have had the “First Dose” vaccine procedure, and exclude by patients who have had the “Second Dose” vaccine procedure. The resulting list of patients will be those who require the second dose and have not yet received it.

You can then use the Recaller output options to create a call list or a form letter.

Will H1N1 Immunizations Appear in Imms and on the Patient School Form?

Contact PCC Support for help setting up the H1N1 vaccines so they will appear on your Partner school form.

How Do I Diagnose, Record, and Track Patients who have the H1N1 Flu?

The H1N1 influenza diagnosis is 488.1: “Influenza due to identified novel H1N1 influenza virus”.

Most of the time, this diagnosis will occur in a hospital setting. If you add the diagnosis to your Partner Diagnosis table in the Table Editor (ted), you can indicate it is a “Major Diagnosis” and then add it to a patient’s record in notjane. You can then use the Major Diagnoses criteria in recaller and other patient reports.

You could also create a patient flag for H1N1, and use the flag to identify, exclude, or include H1N1 patients in reports.