Pediatric Coding Alert

Question: A pediatrician gives multiple vaccines during a visit. Do we include modifier 59 with +90472? Georgia Subscriber Answer: Whether you should append modifier 59 (Distinct procedural service) to +90472 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; each additional vaccine [single or combination vaccine/toxoid] [List separately in addition to code for primary procedure]) will depend on your payer's guidelines. Technically, per CPT you should not need to use a modifier and payers should allow you to report additional vaccines by unit (+90472 x 2, for example). Payers that do not accept units may require you to report +90472 once, then distinguish additional vaccinations with +90472-59. Don't miss: If the physician administered the injection, she probably also provided vaccine counseling during the visit. When that's the case, you should be using 90466 (Immunization administration younger than 8 years of age [includes percutaneous, intradermal, subcutaneous, or intramuscular injections] when the [...]