Primary Care Coding Alert

4 age-, provider-specific 904xx codes ease your vaccine claims

Your family physician (FP) will finally have a way to bill when he counsels parents of young children on immunization administration risks and benefits, starting Jan. 1.

The American Academy of Pediatrics (AAP) has been struggling to get CMS to recognize the work physicians perform when administering vaccines. CMS previously didn't assign a physician work component to vaccine administration codes, says Linda Walsh, senior health policy analyst with the AAP division of healthcare finance and practice. "The AAP has been trying to find a way to make vaccine work payment palatable to the CMS."

As FPs know, administering vaccines to children involves more work than giving shots to the adult population. "Physicians give the majority of vaccines to children under 8 years old," Walsh says. Because the AAP showed CMS the added pre-vaccine work that child vaccine administration requires, the CPT Panel approved four new codes, she says. CPT Adds 4 Vaccine Administration Codes In 2005, you will have eight immunization administration codes to choose from. "CPT 2005 will contain the four existing codes 90471-90474, and four new codes 90465-90468," Walsh says.

Action: Add these four new codes to your 2005 encounter sheet.

90465 - Immunization administration under 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; first injection (single or combination vaccine/toxoid), per day

+90466 - ... each additional injection (single or combination vaccine/toxoid), per day (list separately in addition to code for primary procedure)

90467 - Immunization administration under age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family; first administration (single or combination vaccine/toxoid), per day

+90468 - ... each additional administration (single or combination vaccine/toxoid), per day (list separately in addition to code for primary procedure).

Keep the old codes (90471-90474), which include editorial revisions to 90471-90472:

90471 - Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)

+90472 - ... each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure).

* Change: Codes 90471-90472 eliminate "jet injections." Physicians weren't using this method to administer immunizations, so CPT removed the reference.

90473 - Immunization administration by intranasal or oral route; one vaccine (single or combination
 vaccine/toxoid)

+90474 - ... each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure). Age, Counseling Determine Code Selection The new codes (90465-90468) don't replace the old codes (90471-90474). In fact, you'll use all eight codes. "The new vaccine codes will help you obtain reimbursement for cases in which an FP spends a lot of time explaining and answering questions, especially to new parents," says Daniel S. Fick, [...]