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Bamboo

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Farmington, Connecticut
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As new codes 90460, 90461 replaced 90465~8 starting 1/1/2011, we've got some confusion about the right way to bill immunization in the pediatric office. For instance, to bill immunization for PEDIARIX,Hib,Rota, we have option A or B. Which is right? (our billing system only allows 6 lines for cpt codes).:confused:

Advice(s) will be greatly appreciated.
Bamboo

Option A

icd: 1. v06.8, 2. v03.81, 3. v03.82, 4. v04.89
cpt
90723
90460 (3 units)
90461 (4 units)
90471
90648
90669
90472(2 units)
90680
90473


Option B
icd: 1. v06.8, 2. v03.81, 3. v03.82, 4. v04.89

cpt
90723
90460
90461 (4 units)
90471
90648
90460
90472
90669
90460
90472
90680
90460
90473
 
Here is what I understand for the coding of Pediarex (DtaP-HepB-IPV), Hib, Rotavirus:
90723 (Pediarex) V06.8
90460
90461 x2 (3 components total for Pediarex)

90468 (Hib) V03.81
90460 (one component)

90680 (Rota) V04.89
90460 (one component and the definition states "any method")

90460-90461 can only be reported if physician counseling as described in CPT is provided and the patient 18 or younger.

I hope someone will review this so I know if I'm doing it right. :)
 
We are billing it as indicated in Option A:

90460 x the # of units
90461 x the # of units

I did see the recommendations from the American Academy of Pediatrics to bill it out on every line as you indicated in option B, but I could not find any quidelines stating we can not bill with multiple units.

We are going to monitor to make sure we are being reimburse for all admin of injections.

Also keep in mind if the patient is being seen for a WCC, then you can solely us V20.2 and not the individual codes. We are not experiencing any difficulty from our payers when billing in the manner.

Deanna
 
Thanks Lisa and Deanna, for your quick response and advices. I'll do some claims in option A and some B, and see what happen to the reimbursement.

Deanna, when you said that "if the patient is being seen for a WCC, then you can solely use V20.2 and not the individual codes", what did you mean?:)

Bamboo
 
Last edited:
When they are being seen for their Well Child Check or Well Child Visit (preventative visit) you can use V20.2 linked to all the vaccines and admin codes.

Now keep in mind it is Carrier specific so they may require both V codes. But we have never run into an issue solely using V20.2

Hope this helps!
Deanna:)
 
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