Clear as mud?
This is a very good website:
http://www2.aap.org/immunization/pediatricians/pdf/faqiacodes.pdf
First, you'll need to put modifier 25 on the exam code (or office visit code).
Secondly, it looks like you're mixing the "with counseling" codes 90460 and 90461 with the "without counseling" code for
additional oral/nasal code admin. Trying to bill this without a
first or only admin code will cause denial for not having a primary procedure. The non-counseling codes are set up to reflect "per administration". The with counseling codes are set up to count the individual components of the vaccine. If the physician saw the patient, counseling was most likely done. Here are the quick definitions:
90460 = Admin with counseling by MD, DO, PA or NP. First or only component.
90461 = - Ea additional component.
90471 = Admin without counseling, first or only injection.*
90472 = - Ea additional injection.
90473 = Admin without counseling, first or only nasal/oral vaccine.*
90474 = - Ea additional nasal/oral.
* 90471 and 90473 cannot be reported together.
Using this knowledge, your claim would look more like this:
1-99382-25
2-90460 qty 1
3-90672 qty 1 (or whatever flumist you use)
If the physician didn't counsel, it would look like this:
1-99382-25
2-70473 qty 1
3-90672 qty 1 (or whatever flumist you use)
Feel free to send me an email if you need additional help.
coorbeck@integritymedicalbillingservice.com