Pediatric Coding Alert

Question: We have been using 90471, 90472, and 90473 or +90474 for vaccine administration. Is this correct? Or should we be using 90460 and +90461? Our electronic medical record (EMR) system is throwing out this error lately about how 90471 and +90472 should be billed as 90460 and 90461.

Georgia Subscriber

Answer: The answer to this depends on what was performed and what the documentation says. Let’s take a look at the codes and their definitions. Parts of the definitions are in bold text to more clearly show the differences among them.

• 90471(Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid))
• +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))
• 90473 (Immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid))
• +90474 (Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure))
• 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))

Without a closer look at your documentation, it’s impossible to say which of these codes is correct for a particular encounter, as each set of codes describes a different administration method as well as different components of the service.

The language for 90460 and +90461 states, “… through 18 years of age… with counseling by physician or other qualified healthcare professional.” So, if a physician or other qualified healthcare professional (QHP) and not a member of your clinical staff administered the vaccine, and the pediatrician administered the vaccine to a patient younger than 18 and accompanied it with counseling, then coding 90460/+90461 would be appropriate.

Remember that the AMA says that codes 90460 and +90461 are only for use when the physician or other QHP provides face-to-face counseling during the administration of the vaccine, according to American Medical Association (AMA) CPT^® Professional 2022.