Revenue Cycle Insider

Question: An established patient presented for a routine follow-up visit concerning their moderate persistent asthma. The patient had not received their COVID-19 immunization yet, so the pulmonologist administered the vaccine during the office visit. We initially reported 90480 and 90460, but the claim was denied. We then revised the claim with 90480 and 90471, but that was denied, too. What codes should we report for the vaccine administration?

Pennsylvania Subscriber

Answer: You will only use 90480 (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose) to report the COVID-19 vaccine administration. According to the CPT^® guidelines, “Report 90480 for immunization administration of SARS-CoV-2 (coronavirus disease [COVID-19]) vaccines only.” The guidelines continue to instruct that 90480 includes the administration and counseling for the vaccine for patients of all ages.

You’ll then also include the appropriate vaccine code to report the vaccine dose as follows:

• 91304 (Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use)
• 91318 (Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, spike protein, 3 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use)
• 91319 (… 10 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use)
• 91320 (… 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use)
• 91321 (Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine, mRNALNP, 25 mcg/0.25 mL dosage, for intramuscular use)
• 91322 (… 50 mcg/0.5 mL dosage, for intramuscular use).

Code 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) is designated for a vaccine administration of one or the only immunization of patients 18 years old and younger. You’d assign 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)) for an immunization administration of one vaccine.

Your 90480/90460 and 90480/90471 claims most likely were denied because it appears as though the claims are seeking double reimbursement for vaccine administration.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC