Stay Up to Date with Immunization Administration Claims

Stay Up to Date with Immunization Administration Claims

Perfect coding isn’t hard if you follow the rules — give it a shot.

August is National Immunization Awareness Month (NIAM). According to the Centers for Disease Control and Prevention (CDC), “NIAM was established to encourage people of all ages to make sure they are up to date on the vaccines recommended for them.” Here’s what you need to know to report immunization administrations appropriately.

Administration Is Either with or without Counseling

CPT® designates six codes to report immunization administration, depending on whether counseling is provided at the same time.

Category 1: Administration with Counseling

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
each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)

To report these codes, the provider must document:

Patient age: These codes apply only to those patients age 18 years, or younger. For patients older than 18 years, turn to the second category of administration codes, detailed below.

Face-to-face counseling with the patient and/or family: Parents often have questions about the vaccines recommended for their children, and the provider may spend significant time on education and counseling. The encounter documentation should detail the vaccines given and summarize patient risk factors or concerns, and information shared with the patient/family (e.g., possible side effects and benefits of the vaccine). If the provider does not document face-to-face counseling, turn to the second category of administration codes, detailed below.

The number of vaccine or toxoid components — NOT the number of individual vaccines — administered: Report 90460 for the first component administered, and one unit of +90461 for each additional component administered.

For example:

  • Human papillomavirus (HPV) vaccine includes a single component (90460)
  • Tetanus and diphtheria (Td) vaccine includes two components (90460, +90461)
  • Diphtheria, tetanus, and pertussis (DTaP and Tdap) vaccines includes three components (90460, +90461 x 2)
  • DTaP-haemophilus influenzae type b (Hib) vaccine includes four components (90460, +90461 x 3)
  • DTaP-Hib-inactivated polio vaccine (IPV) vaccine includes five components (90460, +90461 x 4)

The route of administration (subcutaneous, intranasal, etc.) is not a factor to report 90460 or +90461.

Category 2: Administration without Counseling

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)

Unlike 90460/90461:

  • 90471-90474 do not include counseling.
  • 90471-90474 may be applied for patients of any age.
  • 90471-90474 specify the route of administration: Report 90471-90472 for percutaneous, intradermal, subcutaneous, or intramuscular injections. Report 90473-90474 for administration by intranasal or oral route.
  • 90471-90474 are assigned per vaccine, rather than per vaccine component.

Report 90471 and 90473 (depending on the route of administration) for the initial immunization administered. You may report one initial administration code per patient encounter. When both an injected and an oral/intranasal vaccine are administered during the same visit, report 90471 as the initial administration code. If the provider administers multiple vaccines, report each additional immunization using either +90472 and/or +90474, as appropriate to the route of administration.

For example:

  • To report a single intramuscular vaccination, report 90471.
  • To report three intramuscular injections, report 90471 for the initial intramuscular vaccination administration and +90472 x 2 for the additional intramuscular administrations.
  • To report two intramuscular injections — one oral administration and one nasal administration — report 90471 (initial intramuscular vaccination administration), +90472 (additional intramuscular administration), and +90474 x 2 (one unit for each oral/nasal administration).

Mix and Match Codes when
Counseling for Some Administrations

You can mix and match 90460-90461 and 90471-90474 if the provider counsels the patient on some, but not all, of the vaccines or vaccine/toxoid components administered. For example, if counseling is performed for HPV immunization but not for an influenza vaccine provided at the same visit, report 90460 for the HPV administration with counseling, and either 90472 (injected) or 90474 (oral/intranasal) for administration of the influenza vaccine without counseling.

Don’t Forget the Vaccine Supply and Diagnosis

In addition to immunization administration, you typically may report the vaccine supply using a separate CPT® or HCPCS Level II supply code. For example, to report the administration and supply of DTaP; measles, mumps, and rubella (MMR); and varicella vaccines, select:

90700: DTaP vaccine, Intramuscular (IM)

90707: MMR vaccine, subcutaneous (SQ) or jet injection

90716: Varicella virus vaccine, SQ

90471: Administration of DTaP, IM

90472 x 2: Administration of MMR and varicella virus vaccine

All vaccines and immunizations are reported using ICD-10-CM code Z23 Encounter for immunization.


Resources

To learn more, visit the CDC and NIAM websites: www.cdc.gov/vaccines/events/niam.html and

www.nphic.org/niam

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 474 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.

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