Wiki Issue with answers for Day #3

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smontague

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I see that the answer has 90471 and 90472 used for the vaccine admin codes...since the pt was only 2 y/o shouldn't it be 90460 and 90461???? I really thought I had this one right and was stumped as to why my name wasn't on the list yet, then I saw these listed and was curious as to why? Aren't 90460 and 90461 for 18 and under and then 90471 and 90472 are for adult immunizations. I would either like an explanation or for someone at AAPC to check the answers...
 
A rationale for the answer(s) re: Day#3

Hello fellow AAPC coders,

Day#3 of AAPC Coding Challenge 2015
https://www.aapc.com/code/aapc-coding-challenge/answers.aspx?case=3

I think this is the rationale for the answer(s) in this case.

The mom/caregiver was not counseled/given any paperwork on these immunizations in this case #3 scenario of AAPC Coding Challenge 2015 .... It definitely wasn't documented in there that counseling was done; therefore the coder can not report codes 90460 and 90461.
In the absence of counseling, the administrations must be reported with codes 90471 and 90472.

Remember to add the V-codes for the vaccines!!!
The guidelines say: "A code from V03-V06 may be used as a secondary code if the inoculation is given as a routine part of preventive health care, such as well-baby visit."
And under V20.2 it says: "Routine infant or child health check. Any injections given should have a corresponding procedure code."


See reference links
http://www.aafp.org/practice-management/payment/coding/admin.html
http://www2.aap.org/immunization/pediatricians/pdf/faqiacodes.pdf
 
AAPC Coder lists counseling under both admin options

Here is why I have the issue.

I work in a practice where we give childhood immunizations all the time and we always use the 90460-90461 codes for children because the description specifies "through age 18." Even the AAPC coder descriptions list "counseling" under the clinical responsibility for each of these code series. No matter what when the provider gives an immunization they are responsible for counseling...I pulled the following directly from AAPC coder:

90460:
Clinical Responsibility
The provider administers a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age. When the patient is prepped, the provider administers a single vaccine or mix of vaccines or toxoids. He counsels the patient, providing instructions and precautions before immunization.

90471:
Clinical Responsibility
When the patient is prepped, the provider administers a single vaccine or mix of vaccines or toxoids during a single immunization via percutaneous, intradermal, subcutaneous, or intramuscular route. He counsels the patient, providing instructions and precautions before immunization.
 
If you look in the CPT book it states specifically that codes 90460 and code 90461 CANNOT be used unless "qualified health care professional provides face to face counseling". If you are coding with these codes without any counseling you are coding incorrectly.
 
We are coding correctly

We are coding correctly in our office. We hand out the CDC immunization information with every vaccine given, even with adults. And the providers do document this as well as any discussion they have with parent regarding the vaccines. We also document and use the appropriate v-codes when vaccines are refused. :p
 
A rationale for the answer(s) re: Day#3

I use Optum's ICD-9 Expert for Physicians code book and under the V20.2 it states "Immunizations appropriate for age". It does not state that the vaccine V codes need to be listed out separately.
 
Hi Everyone,

We're working to have rationale for each case available in the forum. We'll post previous case rationale when available, and future rationale when the answer is revealed.

Thanks,

Alex
 
I used diagnosis code V06.8 to correspond with the 90748 Hepatitis B and Hib vaccination. Could someone look at this diagnosis to see whether it could also be a correct diagnosis code? It is for a combination vaccination rather than the answer provided which is only for the Hib vaccine. The link below shows that V06.8 is what the American Academy of Pediatrics suggests to go with the 90748. GA Medicaid also requires the V06.8 instead of the V03.81.

http://www.aap.org/en-us/profession...inistered_Pediatric_Vaccines_Coding_Table.pdf


Thank you guys for doing the coding challenge! I have enjoyed being stretched with coding procedures I would not normally code!
 
I would like to get a definitive answer on this as well. I am interpreting this differently & just want to make sure we are all coding vaccines correctly. I disagree with the use of individual "V" codes as necessary on the vaccinations. As stated above; The guidelines say: "A code from V03-V06 may be used as a secondary code if the inoculation is given as a routine part of preventive health care, such as well-baby visit." 1st Keyword SECONDARY - V20.2 is a PDx only so any other dx must be listed as secondary. 2nd Keyword MAY which indicates that using the secondary codes is not required. And under V20.2 it says: "Routine infant or child health check. Any injections given should have a corresponding procedure code." Keyword PROCEDURE as in CPT so that tells me that the CPT for the injection should be billed using V20.2 as well.

In my opinion, the visit & the immunizations may be billed under V20.2 alone. If the immunization were to be given by itself without the well-baby visit, then it would be appropriate to bill V03-V06.
 
2015 AAPC Coding Challenge Case 3

I used code 90645 instead of 90648. Please tell me what is the difference between the two codes.
 
The correct answer was 90748. If you look up comvax, it is Hepatitis B and Hib in the same vaccine, so 90748 would be the correct code rather than 90645 or 90648.
 
90471 90472

from the CPT book it states report codes 90460 and 90461 only when physician or qualified health care professional provides face to face counseling of the patient/family during the administration of a vaccine. For immunization administration of any vaccine that is not accompanied by face to face physician or qualified health care professional counseling to the patient/family or for administration of vaccines to patients over 18 years of age, report code 90471-90474 (see also instruction of use of the CPT Codebook for definition of reporting qualification.)
I hope this helps
 
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