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Pediatric Coding Alert

You Be the Coder:

Half-Dose of Vaccine May Require Second Visit

Published on Thu Dec 04, 2014

Question: Our pediatrician sometimes administers a half dose of flu vaccine instead of a full dose. In one case the child will come back for the other half later because he historically has gotten sick when receiving a full dose, and in other cases the child only gets a half dose because it’s his first flu vaccine ever. The child typically returns a few months later for the other half dose. Should I bill half the charge and use a 52 modifier? 

Answer: Younger children (under the age of three) typically get what could be considered a half dose of the vaccine, but there is a code specifically created for that purpose. You’ll report 90655 (Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use) for this vaccine administration. The child will get a booster one or two months later.
 
If this child is older than three and the pediatrician administers a half dose (which is not typically recommended), you should bill a full dose when the second half is given. Don’t report anything on the day that the first dose is given, unless an E/M visit is medically necessary and thoroughly documented.

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