Wiki Billing 90460 and 90461

[sheprum_24]

Looking for help on Peds immunization administration billing. We are having a discussion on billing 90460 and 90461.

How do you bill insurances for the administration on the below codes?

90645
90670
90681
90723



thanks
Sara

 

[Biller385]

90645 90460
90670 90460
90680 90460
90723 90460 1 90461 4

90460 x 4 90461 x 4

Cathy

 

[rthames052006]

As long as the counseling was done at the same time the vaccines were given.

 

[dcarmichael]

90460 and 90461 units

We have a new client who is a pediatrician. We want to make sure we bill correctly for immunizations.

Example:

99392-25
90656, 90460
90696, 90460, 90461x3
90716, 90460
90707, 90460, 90461x2
90633, 90460

Should the claim be billed as follows?

99392-25
90656
90696
90716
90707
90633
90460x5
90461x5

Thanks so much for your help.

 

[GoLeun22]

99392-25
90656
90696
90716
90707
90633
90460x5
90461x5
QUOTE]

This should be ok, but a mod 25 is not needed on the well visit. I bill both ways for three different pediatric providers.

Lisa

 

[kathleenl]

Hi,
I have a question to add to this thread...I am also new to pediatric billing and the situation I have is that the physician is doing the counseling and then the RN or LPN is actually adminstering the vaccine - would I still use 90460 etc.?

Thanks!
-Kathleen

 

[Cynthia Hughes]

Kathleen - Yes, you can still report 90460. It is not expected that the physician or QHP providing the counseling will actually administer the vaccine. The administration itself is included in the practice expense value of the code.
Cindy