New 2011 admin codes 90460 and 90461

Lisa Bledsoe

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I am trying to understand the correct use of these codes. Specifically, the descriptions state vaccine component and each additional vaccine component. The 2011 CPT Insiders View states that a "component refers for each antigen in a vaccine that prevents disease(s) caused by one organism".
What exactly does that mean?
Does it mean that if 90698 (Petnatcel DTap-Hib-IPV) we would report 90460 x1 and 90461 x2?
:confused:
 
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2011 new vaccine admin codes

That is how I understand it as well. It depends on the # of components in the vaccine and 90460 is first with 90461 used times the number of other components. But also, the patient has to be counseled also either by a physician or a qualified healthcare professional per the CPT book description. So if a patient comes in for shots only and sees the nurse only, I am thinking the nurse is considered a qualifed healthcare professional. If not, we have to use 90471 which is no longer age specific.

Can anyone clarify that for me please? We have a debate going as to whether or not a nurse shot-only visit is considered as counseling. I think it is. Thank you!
 

LindaEV

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I am trying to understand the correct use of these codes. Specifically, the descriptions state vaccine component and each additional vaccine component. The 2011 CPT Insiders View states that a "component refers for each antigen in a vaccine that prevents disease(s) caused by one organism".
What exactly does that mean?
Does it mean that if 90698 (Petnatcel DTap-Hib-IPV) we would report 90460 x1 and 90461 x2?
:confused:
According to the American Academy of Pediatrics, for 90698, you would have 90460x1, and 90461x4 (diptheria, tetanus, pertusis, polio, hib=5 components total)
 

LindaEV

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As far as who qualifies as a "qualified healthcare professional"...thats still not clear to me. From everything I read, I'm leaning toward thinking this means a physician or NP...the actual billing provider. :confused:
AAP says to refer to your states scope practice laws to see who this is....still trying to figure that out!
 

Lisa Bledsoe

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According to the American Academy of Pediatrics, for 90698, you would have 90460x1, and 90461x4 (diptheria, tetanus, pertusis, polio, hib=5 components total)
This is going to completely confuse the nurses and providers. Unfortunately, they do the coding (I educate and do the clean-up). I believe the counseling must be done by the physician or NPP, not the office nurse. Then the question arises, can 90460 and 90461 be reported with the preventive visits when counseling is already considered a factor?
 
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90460 and 90461

The way I understand it you have to code each component antigent example in the cpt book it seems like you will count the Dtap-IPV 2 meaning you will put the 90460x2 and for the the MMR/Varicella combined with Dtap-IPV 90461x6. At work a discussion was brought up on how it should be coded and that was to count every antigen that was given. For example you have the 90696 Dtap-Polio you have the diptheria that is 1st antigen,tetanus toxoids 2nd antigen, acellular pertussin 3rd antigen, and poliovirus 4th antigen.

Now you have Measles that is 1st antigen, mumps 2nd antigen, rubella 3rd antigen, and the varicella 4th antigen.

you would code the first two components the diptheria and the mumps bill the 90460x2 and for the tetanus toxoids,acellular pertussin, poliovirus ,measles, rubella and the varicella these are the other antigens that we will use the 90461x6.
 
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