Pediatric Coding Alert

Question: Should we bill immunization administration code 90782 in addition to skin test code CPT 86580 ?

Massachusetts Subscriber Answer: No, you should not report the immunization administration code 90782 (Therapeutic, prophylactic or diagnostic injection [specify material injected]; subcutaneous or intramuscular) and 86580 (Skin test; tuberculosis, intradermal). The skin test includes the administration. Although 90782 is for a diagnostic injection, you should not use the code when another code exists that more accurately describes the service. Therefore, you cannot report 90782 instead of or in addition to 86580. The other immunization administration codes (90471-90472) are inappropriate as well. CPT assigns these codes for administration of vaccines and toxoids. The TB skin test assesses the presence of the disease. It is not a vaccination. Although 86580 encompasses the administration, it does not include any follow-up. Therefore, if the patient returns to the office to have the nurse evaluate the test results, you may report a nurse visit (99211, Established patient office visit & typically, 5 minutes are spent performing or supervising these services). You may report 90782 with any nonvaccine, nonantibiotic drugs. Injections of pain medications or Decadron for croup warrant 90782. Clinical information for You Be the Coder and Reader Questions provided by Nancy Bischof, MD, private practice, Lexington, Ky.; Mary Gutierrez, CPC, a certified pediatric coding specialist for West Texas Medical Associates in San Angelo; and Kim Kieke, CPC, Austin, Texas.