Pediatric Coding Alert

Question: The physician counsels the patient and family on the human papillomavirus (HPV) vaccine, and the patient receives the vaccination. What code would I use for the counseling part of the encounter? Does CPT offer a way to report administration with counseling codes for children older than the age of 8? If there is no procedure code for the counseling, could I use V65.9?For the vaccine diagnosis, what is the difference between V03.89, V04.89, and V05.8?New Jersey Subscriber Answer: CPT limits vaccine administration with physician counseling codes (90465-90468) to children through eight years of age. For vaccine administration when the patient is older than eight, you should use 90471-90474, which do not contain a counseling component. If the counseling on reducing sexual behavior risks (including getting the HPV vaccine) lasts an approximate 15 minutes separate from any same day E/M service, you could use preventive medicine counseling code 99401 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 15 minutes) and V65.45 (Counseling on other sexually transmitted diseases). Code V65.45 more specifically explains the counseling as compared to V65.9 (Unspecified reason for consultation). Link the vaccine code, 90649 (Human Papilloma virus [HPV] vaccine, types 6, 11, 16, 18 [quadrivalent]), 3 dose schedule, for intramuscular use), to V04.89 (Need for prophylactic vaccination and inoculation against certain viral diseases; other viral diseases), according to the "Commonly Administered Pediatric Vaccines/ Toxoids and Immune Globulins (2008)" (www.cispimmunize.org/pro/pdf/AttachmentB_VaccineCodingTable.pdf) and the American Academy of Pediatrics "HPV Guidance 2007" (http://www.cispimmunize.org/ill/pdf/HPVImplementationGuidance.pdf). Code V04.89 is for vaccination against other viral diseases, whereas V03.89 is for vaccination against a bacterial disease and V05.8 is for vaccination against an "other" specified disease. For the vaccination, report the administration with 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid) with either the vaccine diagnosis (V04.89) or the well visit diagnosis (V20.2, Routine infant or child health check).