Pediarix Billing/Coding

akoschoff

Contributor
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Danville, PA
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Some clinics document the administration of Pediarix as so:

Name Trade Name Route Inj
DTap Pediarix IM RVL
Hep B Pediarix IM RVL
IPV Pediarix IM LVL

They want to charge for the Pediarix code, but the issue I have is that the documentation does not show they were all given in the same location. When I query this, they state it is one injection, and that they will switch the location to all match. They say that they have to record each component separately to show that each was given. I feel when they document it as above, that each component should all be coded out and charged individually (DTap, Hep B, and IPV) with three injection codes rather than using the Pediarix CPT code and one injection code.

I have talked with some people who say that it should be only one injection code since the serum is only being drawn up once. They also say that maybe they administered half in one leg and half in the other due to only so much can be administered in one location.

I guess my questions are:
1. If they document it as above, what is the appropriate way to code this?
2. What is the definition of 'administration?' I was thinking administration was the actual giving of the injection and not the drawing from the vial.
 

smidge1

Networker
Local Chapter Officer
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25
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Vadnais Heights, MN
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Pediarix Coding

Some clinics document the administration of Pediarix as so:

Name Trade Name Route Inj
DTap Pediarix IM RVL
Hep B Pediarix IM RVL
IPV Pediarix IM LVL

They want to charge for the Pediarix code, but the issue I have is that the documentation does not show they were all given in the same location. When I query this, they state it is one injection, and that they will switch the location to all match. They say that they have to record each component separately to show that each was given. I feel when they document it as above, that each component should all be coded out and charged individually (DTap, Hep B, and IPV) with three injection codes rather than using the Pediarix CPT code and one injection code.

I have talked with some people who say that it should be only one injection code since the serum is only being drawn up once. They also say that maybe they administered half in one leg and half in the other due to only so much can be administered in one location.

I guess my questions are:
1. If they document it as above, what is the appropriate way to code this?
2. What is the definition of 'administration?' I was thinking administration was the actual giving of the injection and not the drawing from the vial.
The correct coding depends on the insurance you are billing and documentation. The pediarix is only ONE injection and cannot be broke apart and billed separately as this would be fraud. Code for Pediarix is: 90723 and the injection code will depend on insurance and if counceling was also provided. If no counceling was provided, CPT 90471 for administration. If counceling provided and noted in progress notes, is a PMAP product; then you would code 90460 and 9046 x4. 90460 for the injection and 90461 for each of the additional components in the serum.

Hope this helps.
 

akoschoff

Contributor
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Danville, PA
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So even if the CMA or MA gives the injection in two different spots it still counts as one? That's the part that I'm confused about. They are giving it in two locations but saying it's one...I don't understand how they would decipher which components of the Pediarix were given in a certain location if the components are all mixed together.
 

Jbeck@karuk.us

Networker
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Normally they would only be giving the injection of one vaccine in one spot. Our clinic documents the components in exactly the same way; the MA is supposed to make sure they use the same location for all components. If they pull out the needle and put it back in somewhere else (I have never haerd of doing this), they should be documenting it with the reason in a nurses note. You are coding the Pediarix and the ONLY code you can use for that vaccine is 90723.
 
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