iMMUNIZATION RISK/BENEFIT

MICHELLE1279

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One of our peds is asking if there is a seperate code for MD discusing risks and benefits of immunizations. It appears the parents declined, due to previous reaction. Parents signed a waiver for declining. The only codes I found were when the MD counseled and the immunization was actually administered. Wouldn't the counseling be included in the well child visit 99393 since no administrations took place? Any thoughts?
 

bhaskins1

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Actually, I question this too. If you look at the new code descriptions for 2009 there has been some clarification that the counseling is part of the administration and not the well visit... what does that mean for the patient whose parents decided against the vaccine? Perhaps an e/m based on the additional time counseling? I would love to hear opinions on this. I have the new cpt book and I also have the November AAP Pediatric coding newsletter that addresses how to code for vaccines actually given but does not address when the parent decides not to vaccinate.
 

amp0910

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risk factor reduction codes

I attended a teleconference yesterday which discussed this issue. Here is what the material said they supplied regarding the "Risk Factor Reduction Codes";

  • If counseling goes long due to parental refusal, or confused about the need for vaccines condiser using the preventive medicine counseling codes:
    • 99401: preventive medicine counseling and/or risk factor reduction intervention provided to an individual; approx 15 min
    • 99402: approx 30 min
    • 99403: approx 45min
    • 99204: approx 60 min

      AAP (for example) recommends using these codes when the counseling on a vaccine is more involved than normal in lieu of the vaccine admin codes (90471, 90472,etc)
      -(example) Spent 15min discussing the vaccine required at 2mo and mother states is concerned about Autism. Discussed pro's and con's of vaccines, media info etc. Bill 99401

      -Reimbursement is approx the same as a 99213 to 99214 according to the speaker.

      These codes would be billed in addition to your preventive exam. She didn't say whether this would require a modifier to avoide bundling, but according to CPT I don't see it listed as an add on code, therefore you should add a 25 modifier to your preventive exam code. I have not yet checked with our major carriers to see if this is reimbursed or not. Hope this helps. :eek:
 
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