Pediatric Coding Alert

Question: Our pediatrician administered two single-component vaccines to a 14-year-old female patient. The pediatrician also counseled the patient on the vaccines during the visit. One of my colleagues thinks we should bill 90460 for the first vaccination and 90461 for the second. I think we should bill two units of 90460. Which is the correct way to bill for this encounter?

Illinois Subscriber

Answer: At first glance, the fact that CPT^® describes 90461 (... each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)) as an add-on code to 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) would suggest that your colleague is correct.

However, the notes that accompany both codes paint a different picture. First, CPT^® defines a single-component vaccine as "all antigens in a vaccine that prevent disease(s) caused by one organism." In other words, a single-component vaccine is aimed at preventing one specific disease regardless of the number of antigens contained in the vaccine.

CPT^® then states that you should "use 90460 for each vaccine administered. For vaccines with multiple components [combination vaccines], report 90460 in conjunction with 90461 for each additional component in a given vaccine." So, if the immunization contains a single antigen aimed at resisting one specific disease, you would report 90460; if the vaccination includes a second antigen that is aimed at a second, different disease, you would add 90461 on to 90460.

Consequently, by reporting 90460 with 90461, you are documenting that your pediatrician administered one single-component vaccine with a second, multiple-component vaccine, which is not what happened in this encounter. Instead, as your pediatrician administered two separate, single-component vaccinations, you would report two units of 90460, as you suggest.