Case #3 Winner, Answer Key, & Rational

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Case #3 Winner, Answer Key, & Rationale

Abi L. was the winner of case #3. See below for the answer key and rationale. Sorry for the delay on this one.

CPT: 99382, 90471, 90472 x 4, 90707, 90713, 90700, 90748, 90716
CPT Modifiers: 25
ICD-9-CM: V20.2, V06.4, V04.0, V06.1, V06.8, V05.4

During this encounter the provider performs a preventive service for a new patient. The code is selected based on the patient?s age. Administration of five vaccinations are also performed. Counseling is not documented for the administration codes therefore you report 90471 for the first vaccine and 90472 four times for the additional five vaccines. Modifier 25 is appended to the E/M service as instructed in the CPT? guidelines in the preventive medicine section. There is also an NCCI edit for preventive medicine visits and the vaccine administration codes. A code is selected for each of the vaccine/toxiods.

CPT: 99382, 90471, 90472 x 4, 90707, 90713, 90700, 90748, 90716

Steps to look up: Preventive Medicine/New Patient; Administration/Immunization/One Vaccine/Toxoid; Administration/Immunization/Each Additional Vaccine/Toxoid; Vaccines/Measles, Mumps, and Rubella (MMR); Vaccines/Poliovirus, Inactivated/Subcutaneous; Vaccines/Diphtheria, Tetanus, Acellular Pertussis (DTaP); Vaccines/Hepatitis B and Hemophilius Influenza B (HepB-Hib); Vaccines/Varicella

Answers provided that listed 90472 separately four separate times were also scored as correct because the codes can be billed on separate line items versus multiple units.

ICD-9-CM: V20.2, V06.4, V04.0, V06.1, V06.8, V05.4

Steps to look up: Examination/health (of)/child, routine; Vaccination/prophylactic (against)/mumps with measles and rubella (MMR); Vaccination/prophylactic/poliomyelitis; Vaccination/prophylactic/diphtheria with tetanus/pertussis combined [DTP] (DTap); Vaccination/prophylactic/disease/combination/specified type; Vaccination/prophylactic/varicella

The listing of the vaccination V codes is not required by all payers. AAPC also accepted credit for any answers submitted with V20.2 listed as the only diagnosis.
Last edited:
Case # 3 clinical added to Answer key & Rationale

Case # 3 clinical added to Answer key & Rationale
Since the clinical info wasn't included in posting of answer & rationale; and the link to case clinical info given now is not accessible (error page shows up) .... I thought it wise to include the missing clinical info.

The correct codes are:

99382-25 V20.2
90707 V06.4
90713 V04.0
90700 V06.1
90748 V06.8
90716 V05.4

Hint: The case includes a new patient and vaccines. That means you?ll be using E/M codes! A tool that provides lay terms will be extremely helpful.

Note that caregiver or mom was not counseled/given any paperwork on these immunizations in this case scenario .... It definitely wasn't documented in there that counseling was done; therefore do not report codes 90460 and 90461. Remember to add the V-codes for the vaccines!!!


Chief Complaints/Concerns

1. New patient; 2 year Well Child Exam (WCE) Mom doesn't have immunization record. States that child last shot was when he was 5 months old.

Past Medical History: No significant findings

Family History: Mother is healthy. Father has hypertension

Pediatric Interval Social History

Sleep: There are no sleep concerns.

Activity Level: There are no activity or exercise concerns.

Developmental History: All areas of development are appropriate for age.

Review of Systems:

Constitutional: No fever, irritability or lethargy; good appetite.
HEENT: Sees and hears well; no eye, ear or nasal discharge.
Respiratory: No cough, no audible wheeze, respirations normal.
Cardiovascular: No color changes.
Gastrointestinal: No vomiting, diarrhea or constipation.
Bowel elimination history: There are no bowel concerns.

Nutrition history:

Patient drinks milk from a cup; on demand; of 2% milk daily.
Patient drinks juice from a cup on demand; of varied juice daily.
Patient drinks water from a cup; on demand; of well water daily.
Genitourinary: Normal urine output.
Bladder elimination history: There are no bladder concerns.
Dermatologic: No unusual rashes.
Musculoskeletal: Moving all extremities as usual; normal gait.

Vital Signs:

Height 37.50in
Weight 35.50lb

Physical exam

General/Constitutional: No apparent distress. Well nourished and well developed.
Ears: TM's gray. Landmarks normal. Positive light reflex.
Nose/Throat: Nose and throat clear; palate intact; no lesions.

Lymphatic: No palpable cervical, supraclavicular or axillary adenopathy.
Respiratory: Normal to inspection. Lungs clear to auscultation.
Cardiovascular: RRR without murmurs.

Abdomen: Non-distended, non-tender. Soft, no organomegaly, no masses.
Integumentary: No unusual rashes or lesions.
Musculoskeletal: Good strength; no deformities. Full ROM all extremities.
Extremities: Extremities appear normal.


Routine Infant/Child Health Visit
Immunizations given today:
MMR administered subcutaneously
IPV administered subcutaneously
DTaP administered intramuscularly
Comvax-HIB administered intramuscularly
Varicella administered subcutaneously