Immunization administration coding

cindyde

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As a pediatric office we often given multiple vaccines during a single visit. Some are combination vaccines like DTaP and some are single vaccines like Hep A. Assuming we give a DTaP and Hep A in one visit (which happens frequently), is it appropriate to use the 90460 first component for combination vaccine plus 90461 x 2 for the additional 2 components of the DTaP, and then 90471 for the Hep A or should it be 90472?
Thank you for your help.
C.D'Esposito, RN
 
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Immunization coding

As a pediatric office we often given multiple vaccines during a single visit. Some are combination vaccines like DTaP and some are single vaccines like Hep A. Assuming we give a DTaP and Hep A in one visit (which happens frequently), is it appropriate to use the 90460 first component for combination vaccine plus 90461 x 2 for the additional 2 components of the DTaP, and then 90471 for the Hep A or should it be 90472?
Thank you for your help.
C.D'Esposito, RN

If there is physician or QHP counseling regarding the Hep A vaccine then code 90460 is reported this administration in addition to the unit for the first component of the DTaP. If there is no physician or QHP counseling regarding the Hep A vaccine at this encounter, then, code 90472 is appropriate based on the parenthetic instruction that follows this code in CPT. Hope that helps. Cindy
 

cindyde

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If there is physician or QHP counseling regarding the Hep A vaccine then code 90460 is reported this administration in addition to the unit for the first component of the DTaP. If there is no physician or QHP counseling regarding the Hep A vaccine at this encounter, then, code 90472 is appropriate based on the parenthetic instruction that follows this code in CPT. Hope that helps. Cindy

Cynthia - thank you, I just want to clarify, if a physician sees and counsels the parent/patient regarding the vaccines to be given we would bill using 90460 x 2 and then 90461 x 2. But if the patient is here only for a nurse visit for the vaccines, we would bill using 90460 x 1, 90461 x 2 and 90472?
 
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You code for the vaccine product(s), then you code for the administration. If counseling is provided, you use code 90460 and +90461. If no counseling is provided, you use codes 90471 and +90472. When coding with counseling, you choose codes based on the number of components given; with no counseling, you code for the number of vaccines given, not the number of components.
You will always report 90460 and 90471 only one time (one unit or injection). Each additional unit is reported with the add-on codes +90461 and +90472.

Using your example of DTaP and HepA;
If counseling is provided, you go with codes 90460 +90461. So you'd end up with 90460, +90461 x 3 (plus the vaccine product codes)
With no counseling, you go with 90471, +90472 (plus the vaccine product codes)

Basically if it's with counseling, your units are based on the number of components in total; with no counseling, the units are based on the number of injections. Does that help?
 

JR

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90460 & 90461 administrations on vaccines

When counseling is given by a physician or qualified individual, would a nurse on a nurse visit be qualified? If so then I would use the 90460 & 90461..If not then 90471 would be used?
 
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