How can you bill components of the vaccine when CPT clearly states "it is inappropirate to code each component of a combination vaccine separatey". In NH Medicaid has us bill 90460 for first admin and 90460 w/modifier U1 for each aditional shot.
What you're referencing is talking about the actual vaccine code - not its administration. For example, if a patient gets an MMR triple-shot vaccine, it wouldn't be appropriate to bill the product as 90704 (mumps only), 90705 (measles only), 90706 (rubella only).
The admins are a different story: for whatever reason, AMA has decided that pediatricians are special, and should be reimbursed for vaccine admins based on the number of components in combo drugs, and not by the number of injections/other types of admins given. It doesn't make a lot of sense to me (Why aren't family practice docs paid more for giving TDaP admins?) - it's not like there's extra work involved in administering combo vaccines, just because they've got more than one product in them, and in my opinion, the admin codes should be based off of the actual
work done - they've already been paid for the products.
A shot's a shot, and patients receiving combo vaccines tend to get treated in exactly the same manner as those who receive individual vaccine products - you watch them to make sure they tolerate it, tell the parents what to watch out for, and send them on their way. The 'counseling' provided doesn't really change much, either (you may notice some swelling/redness at the injection site, or a slight fever, etc.).
Many state Medicaid providers tend to agree with that sentiment, and have devised ways to work around paying extra for admins that weren't truly separate 'administrations' - some will flat-out deny the extra components as duplicates, but most have required that they're billed in a certain way (usually, it's more of a pain than other payers' requirements - Medicaid isn't famous for doing things efficiently), and they've adjusted their reimbursement methodologies, to cause the payments for individual and combo products' admins to be relatively close to one another. (For example, if they paid $30 for 90465 in 2010, they might pay $20 for 90460, and $5/unit for 90461x2, for an MMR admin in 2011).
Not to mention, the reporting structure for 90460/90461 is
completely backwards from that of 90471-90474, or from their predecessors, 90465-90468, which
are based off of the number of physical admins, irrespective of the products administered. The whole thing is really confusing, and seems unnecessary. Where I'm from, the saying goes, "If it ain't broke, don't fix it." I think that's applicable, here.
If nothing else, they could at least be
consistent - if combo vaccines warrant reporting extra admin codes, it should be that way for all vaccines (and even therapeutic drugs), regardless of age/product/route of administration. But nobody asked me, so here we are...
