Differentiate Per Vaccine/Per Component Coding for Immunizations

When immunizations are performed, you should submit codes for both the administration and vaccine supply; however, a code for the vaccine is not reported if the vaccine is given to the provider for free, the patient brings the supply, or the supply is provided as part of a clinical trial.

There are three sets of administration codes: 90460/90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional…, 90471/90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections)…, and 90473/90474 Immunization administration by intranasal or oral route….

When reporting 90460-90461, you must verify that counseling was performed and that the patient is 18 years old or younger.

Another common mistake is reporting incorrect units. Codes 90460 and 90461 (unlike 90471-90474) are not reported by the vaccine administered, but per component. When combination vaccines are given, code for each component.

Example: A 1-year-old female is administered MMR and DTaP. During the visit, the provider discusses the benefits of each vaccine and potential side effects, and how to care for the side effects. The codes reported include:

MMR: 90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered, 90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure) x 2, 90707 Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use

DTaP: 90460, 90461 x 2, 90700 Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use.

dec-clearance-sale

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 406 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

One Response to “Differentiate Per Vaccine/Per Component Coding for Immunizations”

  1. jennifer says:

    Hello, I currently work for a specialty practice and have been researching the proper billing and coding of a hep a and b combo vaccine. we only see adults in the practice. and have been denied numerous times due to incorrect submission of claims. any advise ?
    thank you
    jenn

Leave a Reply

Your email address will not be published. Required fields are marked *