Pediatric Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: Please clarify the use of the administration codes 90471 (immunization administration [includes percutaneous, intradermal, subcuntaneous, intramuscular and jet injections and/or intranasal or oral administration]; one vaccine [single or combination vaccine/toxoid]) and 90472 (each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]). Our office is confused as to how to enter the billing for these procedures when three or more injections are given. Do you list each code multiple times? Or can you bill each code adding unit values to the specific code? For example, would you code 90472 x 3 when three separate immunizations are given?

Anonymous California subscriber


Answer: CPT 90471 is for the administration of one single or combination vaccine; 90472 is an add-on code to be used for each additional single or combination vaccine. You would never code 90472 without coding 90471 as well. If you are going to link the vaccine codes to the diagnosis code for well-child care (V20.2), you should use units: For three immunizations, code 90471 with one unit and 90472 with two units. Some insurance companies prefer units. But the American Academy of Pediatrics (AAP) recommends using each vaccine diagnosis code, linking the procedure codes (including administration codes) with those. In that case, you would not use units but rather would list 90471 for the first vaccine, and 90472 for each subsequent vaccine. Lets say a child came in for a four-month well-baby visit, and got DTAP, Hib and polio immunizations. You would use evaluation and management (E/M) code 99391 for the well-baby visit, 90700 for the DTaP vaccine, 90471 for the immunization administration (first vaccine), 90646 for the Hib, 90472 for the Hib administration, 90713 for the IPV, and 90472 for the IPV vaccine.