Wiki CPT Practice Question

[christinaemm87@gmail.com]

I am confused on this practice question :


93. A two-month-old returns for a well check-up and several shots (Rota, DTaP-HepB-IPV, Pneumococcal PCV13) with her pediatrician. He offers suggestions to the mom, completes the exam, and counsels her on the vaccinations. How should this be coded?

A. 99391-25, 90460, 90461 x 2, 90680, 90723, 90670

B. 99381-25, 90471, 90472 x 2, 90474, 90680, 90700, 90648, 90670

C. 99381-25, 90471, 90472 x 3, 90680, 90723, 90670

D. 99391-25, 90460 x 3, 90461 x 4, 90680, 90723, 90670 The answer is D, but why is it D. Why is 90460 reported X3 and 90461 reported X4. thought there was only three vaccinations given so why are you reporting 4 vaccines? Thank you Christina

 

[thomas7331]

Look at the descriptions for 90460 & 90461 - also see the instructional note for these codes in CPT which states: Use 90460 for each vaccine administered. For vaccines with multiple components [combination vaccines], report 90460 in conjunction with 90461 for each additional component in a given vaccine.

So you have three vaccinations here:

• 90670 and 90680 each have one component, so they are coded as 90460 (x 2).
• 90723 has five components, so it is coded as 90460 (x 1) and 90461 (x4).

So when you add these all together, you get 90460 x 3 for the three vaccinations, plus 90461 x 4 for the additional components.

 

[csperoni]

The DTaP-HepB-IPV is a combination vaccine. Here is a good article from American Academy of Pediatrics explaining it:

https://www.aap.org/en-us/Documents/coding_faq_immunization_administration.pdf

 

[Mperkes72]

So I have a similar question. Medicaid you can’t bill the antigens so if I gave 3 shots for under the age of 18 , could I use the one code 90460 *3 or does it also have to have addition 90461 ?