Move Over 2015 Vaccine Coding
Make room for CPT® 2016 updates.
Over a dozen of the 60 changes affecting vaccines in CPT® 2016 consist of deleting outdated, unused codes (e.g., 90735 Japanese encephalitis virus vaccine, for subcutaneous use was deleted). Nearly four dozen other changes involve descriptor revisions, typically without altering code use (e.g., the acronym for varicella virus vaccine (VAR) was added to the descriptor of 90716 Varicella virus vaccine (VAR), live, for subcutaneous use). There are also four new vaccine codes:
90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB), 2 dose schedule, for intramuscular use
90621 Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB), 3 dose schedule, for intramuscular use
90625 Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use
90697 Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use
The MenB vaccinations are newly available vaccinations developed to target another serogroup of meningitis; they do not replace the current meningococcal vaccinations. According to the World Health Organization, the cholera vaccination is not available in the United States, but it is being used in other countries where cholera is more prevalent.
Vaccine administration codes are unchanged in 2016. Codes 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 and +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) describe vaccination administration for patients age 18 years or younger when the provider counsels (and documents) the patient and/or guardian on the risks, benefits, and potential side effects of the vaccination. The codes are reported based on the number of components in each vaccine. Code 90460 is billed for the first component of each vaccination, and +90461 is billed for each additional component (with as many units reported, as applicable).
For example, Tdap has three components: tetanus, diptheria, and pertusis. This is billed 90460 x 1, 90461 x 2. If Tdap and a flu shot are both given, report 90460 x 2 (one unit for the first component of Tdap, and one unit for the flu shot) and 90461 x 2 (for the additional two components of Tdap).
For patients 18 years and under, when no counseling is given, or for anyone over 18, vaccinations are billed using the following:
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
+90472 each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
90473 Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)
+90474 each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
These codes are billed per vaccination, with either 90471 or 90473 (according to the route of administration) for the first vaccine and +90472 or +90474 for each additional vaccination. Codes 90471 and 90472 describe intramuscular (IM) or subcutaneous injections; 90473 and 90474 report oral or intranasal. Note that either 90471 or 90473 can be billed for the first vaccination; if you administer one IM vaccine and one oral vaccine, you may report either 90471 and +90474 or 90473 and +90472.
Remember: Medicare specifies its own administration codes. G0008 Administration of influenza virus vaccine is for administration of a flu vaccination, G0009 Administration of pneumococcal vaccine is for a pneumonia vaccination, and G0010 Administration of hepatitis b vaccine is for a hepatitis B vaccination.
Administration code 96372 Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular is to be used for therapeutic injections, not vaccinations — but as with all coding, check with the payer for their specific guidelines regarding vaccination administration billing.
Karla Hurraw, CPC, CCS-P, is the billing office team lead for DeKalb Health Medical Group at DeKalb Hospital in Auburn, Ind. She is a member of the Fort Wayne, Ind., local chapter.