CPT add-on 90474 oral/nasal admin


Oxford, NJ
Best answers
I hope someone can help clarify this billing scenario for us:

When a patient receives 3 IM vaccines and 1 nasal admin vaccine
our claim is billed with admin codes: 90471, 90472 with 90473 on
one date of service
(because only 1 nasal admin was provided we do not use the add-on
code 90474)

In this scenario would it be correct to bill 90471, 90472 with 90474 ?

or would you add the 59 modifier to the 90473 to indicate a
distinct service?

Appreciate feedback!!

I'm not sure if this will be helpful but I hope so! According to CCI, 90473 is considered a component of 90471 & therefore not separately billable. Also, the indicator on the code is "O", which means that -59 cannot be appended.
Per CPT guidelines code 90474 is for each additional vaccine (intranasal or oral) and should be used in conjunction with 90471 or 90473. If you are coding 90471, 90472 and an intranasal or oral vaccine you should use the 90474 not the 90473.

But you can only use 90474 in conjunction with 90473, as per cpt guidelines.

It would then be my understanding that if you can't bill the 90473 (according to CCI) with a 90471 because they are considered mutually exclusive, then you wouldn't be able to bill for the add-on code of 90474. You can't bill for an add-on code without the "main" cpt code that it corresponds to.

Any thoughts...
Just thought I would share one more tidbit. If you look in CPT
under + 90474 in parenthesis is states "Use 90474 in conjunction
with 90471 or 90473"

I put the code pair 90471 and 90474 through Correct Code Check
and it did not bring up an edit. :) :)
One more word to the wise: As there can be only one "first" admin (whether oral or injectable), make the initial code whichever reimburses higher If they're unequal. Good advice I got from the Pediatric Coding Alert newsletter.
coding for nasal/oral with injected vaccinations

Here is how I do these:

Per the guidelines 90471 and 90473 can not be coded together.

So, in order to code it right, I code the nasal/or oral vaccine first, then I code all other injected vaccines with 90472 plus units.

For example: Patient receives Flumist, Pediarix, Pneumococcal and Hep A

1) V04.81 link with 90473 and 90660
2) V06.8 link with 90472 (x 3 units) and 90723
3) V03.82 link with 90669
4) V05.3 link with 90633.

These took me a while to figure out.

Same if you code for flumist (nasal), rotateq (oral), and 2 injected vaccines.

1) V04.81 with 90473 and 90660
2) V04.89 with 90473 and 90680
3) V03.82 with 90472 (2units) and 90669
4) V05.3 with 90633

Hope this didn't confuse you completely.

I code the first immunization administration 90471, each subsequent 90472 and the intranasal/oral 90474. The only time you would use 90473 is if it is the only administration performed. Hope that helps. :D