90465 & 90467

cynthiar

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I have a pediatrician that states he has heard that CPT codes 90465 and 90467 were changing, and that "immunization administration younger than 8 years of age" would no longer apply and that the patient could be any age.
Any one have any knowledge of this or changes coming for 2009?
Please advise.
Thanks
C. Robinson, RT, CPC
 

jllgood

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I'm not sure about this, but do you happen to know if the 90465 can be used with a nurse practitioner billing incident to the physician?
 

jlalmond

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90465,90467

What does the "face-to-face" counsel during administration consist of? Does provider have to be present when the nurse is giving vaccine? Can provider just tell pt. recommended vaccines and ask if any questions?
thnks
 

bhaskins1

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What does the "face-to-face" counsel during administration consist of? Does provider have to be present when the nurse is giving vaccine? Can provider just tell pt. recommended vaccines and ask if any questions?
thnks
It does not say the physician has to administer the vaccine, just counsel..... just my take on it.
 

medcode12

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Clarification on 90465/90466

So the only way to use these 2 codes is if the physician counsels on them, right? If they do not counsel, one should bill 90471-4 even if the patient is age 8 or below?
 

RebeccaWoodward*

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I have a pediatrician that states he has heard that CPT codes 90465 and 90467 were changing, and that "immunization administration younger than 8 years of age" would no longer apply and that the patient could be any age.
Any one have any knowledge of this or changes coming for 2009?
Please advise.
Thanks
C. Robinson, RT, CPC
Is this what you're looking for?

http://www.ama-assn.org/amednews/2008/10/13/hll21013.htm
 

medcode12

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Not necessarily. I think I was just confused on whether or not 90465/90466 could be used if the physician did not counsel on the vaccines. And also if the doctor actually had to state in the chart that counseling was done.

I've been searching the web and it seems counseling has to be done and the doctor should state so in records.
 

bhaskins1

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So the only way to use these 2 codes is if the physician counsels on them, right? If they do not counsel, one should bill 90471-4 even if the patient is age 8 or below?
You've got it... you can bill 90471-4 for any age but 90465-8 is more appropriate to code if the child is under 8 and the physician talks to the parents on that day about the vaccine (risks, benefits, etc).

Example: Johnny Doe gets his first Hep A vaccine at the age of 14 months. The Dr. documents that he talked to Johnny's Mom about the risks and benefits of the vaccine. 90465 would be used for the administration of this vaccine. Johnny returns to the office in 6 months for the sole purpose of getting his second Hep A vaccine and the nurse administers the vaccine without the patient seeing the Dr. 90471 would apply to this administration because the physician did not counsel the parent again. (if the parent had questions about the vaccine and the physician did counsel them again the 90465 would apply)

And Yes if the Dr does not document that he discussed the merits of the vaccine then he didn't do it and you should code the 90471-4.

Hope this helps!:D
 
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bhaskins1

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I just received my AAP Coding for Pediatrics 2009 book and it shows the description for 90465-90468 stays the same.
 
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