Coding HPV vaccine in Pediatrician office


Denver, CO
Best answers

Could someone help me? I am new to coding... When a patient comes in the office and received an HPV vaccine and the Physician counsel the patient and family. What code would I use for the counselng part of it? I am at a lost because in the CPT Manual there are counseling codes only for children younger the eight years of age.

Is there any counseling codes for children above the age of 8 years of age? And my next question is when using a dx code for the HPV which is the difference between V04.89 and V05.8 I' m at a lost. And if there is not a procedure code for the couselng part of it would I be safe, billing with a dx code V65.9 which is Unspecified reason for consultation?:

Final question, when a patient comes in the office for other problems but received a vaccine. How would you code? because with some insurance companies if you bill a 99213 with a Vcode there are times where the claim will either deny because youre billing an office code 99213 with a preventive dx code. Or the claim will be paid but when you actually bill a well visit it may deny because the pt is limit to a certain amount of preventive care.

Could someone please help me I;m at a lost.


Linda B
Administration Code with Vaccine Code

I too am new to coding. I just reviewed some office fee tickets and they do not have ANY administration codes on them--in other words, they have been billing for the vaccine, but never the ADMINISTRATION of the vaccine. I am sure that this can't be correct. I realize through the Vaccines for Children program, the vaccine is provided free, and I believe we get $5 for the administration, but commercial payers have not been billed for administration, or the VFC program....Can someone help me please? The only other way I can find out is asking the payers, and I really don't want to look that stupid!
For the counseling with the HPV vaccine I would look at 99401 and V65.45 and use these in addition to the admin and serum codes. Just note that 99401 is for 15 minutes.

As for the vaccination at a problem visit, you should be attaching the problem dx to your E&M code and only use the V codes for that admin and serum codes for the vaccination.

Hope this helps

Hello - I will just give you some advice on the HPV vaccine. I went through an ordeal on the patient end and coding end when I took the vaccine myself. Your vaccine code is 90649 for Gardasil, it took the V04.89 to get all three of my claims paid. I also had an issue with an office visit being billed in conjunction with the vaccine so if you get a denial on that vaccine or counseling code, I ended up having to split the claim so the diagnosis code for the office visit didn't interrupt the HPV vaccine, this particular insurance was a pain! Hope your payor proves better! Good Luck!!
Coding HPV vaccine in Ped office

Linda B, (and others)
I have been billing for Peds for several years. If you call me, I will walk you thru how to bill your Prev visit, problem visit, vacc, and adm altogether and get PAID....