• If this is your first visit, be sure to check out the FAQ & read the forum rules. To view all forums, post or create a new thread, you must be an AAPC Member. If you are a member and have already registered for member area and forum access, you can log in by clicking here. If you've forgotten the password it can be reset on our sign in section by entering your registered Email Address or Username here. To start viewing messages, select the forum that you want to visit from the selection below..

New CPT codes 90460 and 90461

D

DebbiePottsEngland

Guru
Messages
168
Location
Dickson, TN
Does anyone have insight on these codes yet? I don't have my new CPT book and have already been asked about them by my Director. Any help would be appreciated.
thanks
Debbiep
 
90460-90461

90460 - immunization admin thru age 18 via any route with counseling first vaccine

90461 - immunization admin thru age 18 via any route with counseling each additional

These go into effect on 1/1/2011. :D
 
That is correct. The admins are applied to each component (antigen) of the vaccine. For example, the admin for an influenza vaccine would be 90460 even though different strains are involved. The admin for MMR would be 90460, 90461, 90461. I was advised to list the admins separately, not 90460, 90461 x 2 to avoid denials.
 
Hi, could someone please advise where this information is coming from? I cannot locate this anywhere and I too do not have my 2011 cpt book yet.
Thank you so much!:):):)
 
I finally received my CPT book and the codes in question are for counseling for each componet as will as adminstration as far as I can tell. They do not replace the 90471 or 90472 or the other administration codes. they are in addition to them.
 
per the AAP:
Immunization Administration Coding Changes
Starting next year, there will considerable changes to the reporting of immunization administration (IA). New CPT codes become effective on January 1, 2011 as follows:

90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component.

+90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (list separately in addition to code for primary procedure)

The new codes are reported based on the number of vaccine components rather than the number of injections/administrations.
 
per the AAP:
Immunization Administration Coding Changes
Starting next year, there will considerable changes to the reporting of immunization administration (IA). New CPT codes become effective on January 1, 2011 as follows:

90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component.

+90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (list separately in addition to code for primary procedure)

The new codes are reported based on the number of vaccine components rather than the number of injections/administrations.
 
Determining the number of components in each vaccine

Is there an easy way to determine the number of components in each vaccine ? Is there a guide somewhere ?
 
It is my understanding that Tdap has three components( tetnasus deptheria, acellular pertusis), MMR has 3 componets( measles, mumps, rubella), etc. If anyone has another opinion it would be appreciated.
 
I understand how to use the new "90460" and "90461" but when would use "90471 and "90472"? Would that be for a flu clinic, where there is no counseling, patients just walk in and get the flu shot?
 
dburchett said:
I understand how to use the new "90460" and "90461" but when would use "90471 and "90472"? Would that be for a flu clinic, where there is no counseling, patients just walk in and get the flu shot?
Click to expand...

From what the AAP has published about the subject... yes you would use 90471-74 when there is no physician counseling. This also applies when a physician does not counsel for the additional vaccines in a series (HPV etc...)

example if a physician documents that they personally performed the vaccine counseling on MMRV (4 components) you would bill for the vaccine, then code 90460 1 unit, 90461 3 units for the administration of the MMRV. If the physician does not document counseling then you can only code 90471 for the administration. This would greatly reduce your reimbursement on the administration of that vaccine.

If a child is there for their second, third, etc in a series and the physician does not provide additional counseling then only a 90471-90474 can be coded.

Also according to the AAP the appropriate way to code would be with units, so insead of 90460, 90461, 90461, 90461 you should code 90460, 90461 x3 units.
 
Last edited:
Hi Debra, I am new to pediatrics billing could you give me an example of how to code these new Imm codes. I would really appericate it.
 
I just want to make sure that I understand....

A 16-year old, established patient presents to the office with her mother for her annual exam. The provider orders the influenza and Tdap vaccines. The provider counsels the patient’s mother prior to the administration of vaccines, the counseling is documented in the chart, and the nurse administers the vaccines.

Using these new codes, you would report:

99394 (annul exam, established patient, ages 12-17)
90658 (influenza vaccine, split virus)
90460 (administration of influenza vaccine)
90715 (Tdap vaccine)
90460 (administration of first component of Tdap vaccine)
90461 (second component of Tdap)
90461 (third component of Tdap)

If you were going to report in units, would you report?

90658
90460 X 1
90715
90460 X 1
90461 X 2

or

90658
90715
90460 X 2
90461 X 2

Thoughts?
 
The 90460 is only listed once per claim. and you use them only if the patients( parents) were counselled about each component. it is less likely that happens when in is the second, third and fourth shot is a series. The doctor will need to document the counseling. then 90460 for the first componet and 90461 for each component there after even if there are multiple injections and each injection has multiple components. This is my interpretation of this so far.
Hope it helps and if anyone has more informtion please share.
thanks
 
I think it should be 90658, 90715, 90460 x 1, 90461 x 3 are you sure there was counseling in the flu vaccine? I have multiple and am rarely counseled. in that instance I would bill 90658, 90715, 90460 x1, 90461 x2, 90471. of course I don't have the CCI on this yet. I do have a print out from something some one sent me. If you send me an email to Dpotts@dicksonmd.com I will send it to you so you can look at it.

thanks
 
debbiep said:
The 90460 is only listed once per claim. and you use them only if the patients( parents) were counselled about each component. it is less likely that happens when in is the second, third and fourth shot is a series. The doctor will need to document the counseling. then 90460 for the first componet and 90461 for each component there after even if there are multiple injections and each injection has multiple components. This is my interpretation of this so far.
Hope it helps and if anyone has more informtion please share.
thanks
Click to expand...

Debbie, I think the information above is incorrect. The 2011 CPT instructions (pg.450) state "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 for example, MMR (90707) and DTaP (90700) are given and physician provides vaccine counseling for all vaccine components, the vaccine and admin charges would be reported as follows:

90707 - MMR
90460 (measles)
90461 x2 (Mumps, rubella)

90700 - DTaP
90460 (diphtheria)
90461 x2 (tetanus, acellular pertussis)
 
Interesting.....if you report the above example as:

90658
90715
90460 X 2
90461 X 2

then would you not be reporting 90460 per vaccine? Or are you saying you report 90460 as a line item for each vaccine given?
 
dballard2004 said:
Interesting.....if you report the above example as:

90658
90715
90460 X 2
90461 X 2

then would you not be reporting 90460 per vaccine? Or are you saying you report 90460 as a line item for each vaccine given?
Click to expand...

Dawson, report 90460 as a line item. If you are a member of the American Academy of Pediatrics (or one of your physicians is), there's an excellent Q-and-A about the 2011 admin codes on the AAP website.
 
Another question here.....per this document from the AAP, an RN may be able to report these codes if he/she provides counseling first prior to the vaccine, I went to a workshop sponsored by the AMA and their stance is that 90460/90461 can only be reported by a MD or mid-level provider (i.e. NP or PA). Can someone please clarify? Thanks.
 
90460-90461 coding when an RN does counseling

does anyone know if the rationale for "or other qaulified health care professional" includes an RN, or are only MD, NP, CNM, PA consider in this role?

In other words could you use this code for a pediatric immunization where the RN did the counseling and Admin?

Thanks
G Tassinari, CPC, PCA
Billing Manager
PCHC
 
Last edited:
90460....

Hi ,

I was asked what if a doctor does the counseling and the MA administers the vaccine, can we still bill 90460 or the dr has to do the counseling and the administration?

thanks
Celine
 
90460- administration/couseling

http://www.aap.org/immunization/pediatricians/newsletters/November2010_enews.pdf

Please see page 5 "special section".

It says that
"The pediatric IA code (90460) is reported only when both of the following requirements are met: 1. The patient must be 18 years of age or younger and 2.The physician or other qualified healthcare professional (refer to state scope of practice laws in your state) must perform face-to-face vaccine counseling associated with the administration(Note: Any clinical staff can do the actual administration ofthe vaccine.)
'
 
my understanding is that you must report the 90460 and 90461 per component, so if you were doing an MMR and DTaP you would code the 90460 and 90461 x2 for the MMR and then 60460 and 90461 x 2 for the DTaP.
 
90460 -90461 question

I need to know if i can still use cpt codes 90465 to 90468 on claims after january 1 2011, the reason is my emr software still not have this news codes load in the system . I appreciate any help. thank you
 
fsan1984 said:
I need to know if i can still use cpt codes 90465 to 90468 on claims after january 1 2011, the reason is my emr software still not have this news codes load in the system . I appreciate any help. thank you
Click to expand...

You may use them only if your DOS is prior to 01/01/2011. The codes are deleted effective 01/01/2011. If you use them on claims with DOS on or after January 1st, your claim will be denied.

Becky, CPC
 
The website is: http://practice.aap.org
It will tell you all about the new codes & give you examples that are REALLY helpful!

But does anybody know about reimburstment b/c the Insurance fee schedules are not reflecting the reimburstment for 90460 & 90461.
 
Does anyone know how much to charge for these codes??? And yes all the information is on the aap website look at the newsletter for November 2010 there is a lot of info in there.
 
Hello,

I need help with something. What is enough documentation to report that counseling was done? Our providers document that the patient/parent was given the VIS form, is this enough? Do providers have to actually document "vaccine given and counseling completed", or something like that?

Thanks a lot!
 
I have only seen a few insurance plans actually saying how they will reimburse for these new codes, but here is the info I have! Hope it helps everyone!
Cigna - "will not apply duplicate edits on these codes and will allow multiple submissions of these codes per claim"
Anthem - "will be paying the lines for these codes unbundled. HOWEVER, when billing for HMO they do need to bundle these charges, so for HMO must bill multiples of the same code on one line with multiple units, or all additional lines will deny as duplicates"
United Healthcare - "it is common coding practice for some CPT and HCPCS codes to be submitted with multiple units. However, when reporting the same CPT or HCPCS code on multiple lines and/or separate claims, the claim line may deny as a duplicate service. Maximum Frequency per Day values apply whether a physician or other health care professional submits one CPT or HCPCS code with multiple units on a single claim line or multiple claim lines with one or more unit(s) on each line for the same date of service for the same patient."

My Anthem provider rep said "This billing methodology change will increase vaccine admin code occurrences by at least 82% in VA, which means a significant increase in payout to PCP's"

Hope this info helps!
Allyson
 
MMR - measeles,mumps & rubilla ( 3 components)
DTaP - diphtheria; tetanus & acellular pertusis ( 3 component )
read the march edition of AAPC magazine. Every thing is explained clearly.
 
Has anyone gotten any good responses to the new 90460 and 90461 CPT codes? Every insurance comapny that I talk to has a different response to how to code these from adding modifiers to bundling all the 90460's and 90461's with units. This is not what I was taught and there doesn't seem to be an end in sight on getting this issue fixed. Does anyone know when this might happen and what our options are regarding these codes?:confused: Cristina Lane, CPC
 
Billing of 90460 and 90461

I seem to be having problems getting a grasp on how Medical Mutual of Ohio and Anthem for Ohio want these codes billed. It seems as though when I bill the 90460 as one unit on individual multiple lines they are getting denied as duplicate and then I am having to appeal them. :(

Does anyone have a breakdown on how the major carriers want these codes billed? :confused:
 
I just read that there has been a correction for the CPT 2011 book with regards to this:
"On page 5 of the CPT Errata is the reference to vaccine immunization codes….”A component refers to all antigens in a vaccine that prevents disease caused by one organism. Combination vaccines are those vaccines that contain multiple vaccine components.” Revise the immunization administration for vaccines/toxoids guidelines to include reference to all administration codes, and include reference to “all antigens in a vaccine that prevent disease(s)." Would you interpret this to mean that you go back to adding 90460 for the 1st vaccine and 90461 for each add'l vaccine as we did before 1/1/11?? Please let me know what you all think....
 
You must log in or register to reply here.
Top