Vaccine Administration Codes To Be Fixed for CPT 2000--But What Should You Do Now?
Published on Sat May 01, 1999
It is clear that the new vaccine administration codes (90471 for one vaccine, and 90472 for two or more), which were supposed to help pediatricians by giving them a way to bill for administration, are causing a tremendous problem for many practices. The biggest problem is the two or more. If, say, you charge $15 to administer one vaccine, and $30 to administer two or more, what happens if you have to administer three vaccinesor more? And this, of course, is assuming that the managed care company will pay you the $15 or $30 you have attached to those codes on your fee schedule. What is actually happening is that many pediatricians, who give more multiple immunizations by far than any other specialty, are losing money because of these new codes.
But next years CPT will have a solution. Instead of being for two or more vaccines, the second code will be for each subsequent vaccination, says Charles J. Schulte, III, MD, FAAP, the American Academy of Pediatrics representative on the American Medical Associations CPT coding committee. The second code has already been approved, says Schulte, who practices in Sterling, VA. This, at least, will make it possible to bill for each vaccine you draw down.
Also good newsit is expected that relative value units (RVUs) will finally be assigned to the two new codes (remember, one will be for one vaccine, and one will be for each subsequent vaccine). There will be an RVU for each code, says Schulte. This will help pediatricians determine what to charge. And more to the point, the existence of an RVU will be guidance to insurance companies on what they should pay.
In the March issue of PCA, one practice was reported as using units to charge for administration of more than two vaccinations. This strategy is working well: One managed care company is paying $5 for one shot, $9 for two shots, and $12 for three shots (not even close to the $15 per shot on the practices fee schedule, but still there is extra reimbursement for more than two vaccines).
However, using units for CPT 90472 is problematic, since CPT specifically states that the code is for two or more single or combination vaccines/toxoids. The use of units is not compatible with the language thats in CPT, says Peter Rappo, MD, FAAP, chairperson of the AAP Committee on Practice and Ambulatory Medicine. I think this could be very difficult, says Rappo, who practices in Brockton, MA. But Schulte disagrees. If a practice has a local agreement with payers, using units is okay, he says.
The Universal State Problem
However, the new verbiage wont solve another problem practices are having. Rappo, for example, [...]
