Question about 90460-90461 and 90471-90474 Used together

danielle0419

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Please help me Understand. I was reading this article from AAPC regarding the use of 90460-90461 & 90471-90474. I thought you could only use 90471-90474 for 19 and over. But the second paragraph about counseling & non-counseling can be mixed confuses me about using 90460 and 90472 "Non Counseling together. How can you use a Under 19yrs old code"90460-90461" and a over 19 code "90471-90474" together?:confused:[/COLOR]
 

btadlock1

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Please help me Understand. I was reading this article from AAPC regarding the use of 90460-90461 & 90471-90474. I thought you could only use 90471-90474 for 19 and over. But the second paragraph about counseling & non-counseling can be mixed confuses me about using 90460 and 90472 "Non Counseling together. How can you use a Under 19yrs old code"90460-90461" and a over 19 code "90471-90474" together?:confused:[/COLOR]
I think you may be misreading the guideline...You don't use 90460/90461 for anyone over 18, regardless of whether or not counseling is provided. "Counseling" is likely to be provided all at once, if at all, during an encounter. If your patient is under 18, and counseling is provided (eg, the provider advises them of what kind of adverse reactions to look for, and what to do if they happen), then use 90460/90461. If they are over 18, or if they just walk in, get the shots, and walk out, with no advice such as "they may feel tired, or run a slight fever" or "the injection site may turn a little red" was given (and documented, of course), then you'd use 90471-90474. You're probably not going to have any situations where you'll need to use codes from both sets at the same time. Hope that helps! ;)
 

danielle0419

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I do understand what you are saying. But the July Article. states that If a Patient gets a HPV and a Influenza and councling was only give for the HPV. its states to use 90460 for the HPV and 90472 for the Influenza.
 

danielle0419

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I guess the real question is
Can you use 90471-90474 for children if the provider did not do or doesn’t document they did counseling.
 

btadlock1

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I guess the real question is
Can you use 90471-90474 for children if the provider did not do or doesn't document they did counseling.
Yes, you actually have to. The guideline states:
"Report codes 90460 and 90461 only when the physician or other qualified healthcare professional provides face-to-face counseling of the patient and family during the administration of the vaccine. For immunization administration of any vaccine that is not accompanied by face-to-face counseling, report codes 90471-90474."

If you did run across an instance where you'd have to use 90460 and 90471-90474, you would actually use either 90471 or 90473, first. 90472 and 90474 are add-on codes that must be used in conjunction with 90471 or 90473. 90460 and 90461 are in a different category, so billing 90460 doesn't count as the "initial" immunization administration from the other set of codes. I can almost promise you that if you end up having to bill this way, you're going to have to appeal a claim denial with records. You have a 99% chance of confusing a claims edit system, but the correct way to bill a situation where someone under 18 received 2 vaccines, but was somehow only counseled for one, would be using 90460 & 90471. Hope that helps!
 

jackson7591

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reference

http://www.nxtbook.com/nxtbooks/aafp/fpm_20110102/index.php?startid=6#/7/OnePage

Here is a nice article, page 5 and 6. It is a bit slow to load, and information is consistent with btadlock's response. It provides not only the same information but also some insight with regard to the reason these codes have changed? Makes it a bit easier for me to retain the information.

The information is consistent with Brandi's useful post.

hope it helps
 
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lmildner

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90460 & 90471

I am trying to understand if the 90471 is billed like the 90460 in regards to billing each component. It doesn't look like it is based on the coding book. Appreciate any help on this matter.
 
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I am trying to understand if the 90471 is billed like the 90460 in regards to billing each component. It doesn't look like it is based on the coding book. Appreciate any help on this matter.
No, 90471 is not billed by component. CPT states "Immunization administration........1 vaccine (single or combination vaccine/toxoid); therefore, it is billed by vaccine and not by component.

I hope this helps!
 
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What if counseling is provided just for one of the components of the vaccine. E.g, in case of Tdap, if counseling is just provided for the component of diphtheria, what would be the coding for this. Only this vaccine is provided. Thanks in advance for any responses.
 

jchabolla

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Counseled and NonCounseled during same visit

A patient is recieving 90715 (3 components) and 90733 (1 component), but the physician is marking 90471, 90472 (1 unit), 90460, and 90461 (2 units).

If one is counseled and the other is not, shouldn't this be specified?

I would assume that the 90715 would be getting the counseled 90460 and 90461 to cover all 3 components. And, the 90733 would get the 90471. But that would leave the 90472.

Is there a rule where the counseled codes can not be used on the same vaccine with non-counseled?

Please help.
 
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90460, 90461 Medicine Section

According to CPT-2014 it looks like you have to unbundled under 18 yrs. (ex) Rota, DTAP-Hib, PCV would be coding like this -
90460X3, 90461X3,90680,90721,90669 does anyone know when this change took place ( We checked old CPT books they didn't indicate you had to unbundled under 18yr.) PLEASE HELP going to take the test soon.


Martha
 
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