Wiki Re: Proper Vaccine administration coding

[Kar116]

Re: Proper Vaccine administration coding

Ok, I have seen plenty of posts on how to code the new vaccine administration coding that took effect 1/1/2013, but I am confused how to code each scenario; for example, how do you determine the component # for 90460 and 90461 and which diagnoses fall under each of these CPT codes? Here is an example I am working on at work:

Medicaid claim was originally coded as this:

90648-SL V03.81
90723-SL V06.8
90670-SL V03.82
99391-25 V20.2

Do I code like this?
90460-SL V03.81, V03.82 (2) units
90461-SL V06.8 (3) units
90648-SL V03.81
90723-SL V06.8
90670-SL V03.82
99391-25 V20.2

The SL modifier is used for state license vaccines for Medicaid claims. Hopefully you can help me clear my brain and/or is there a website that would help me as well? I have a slew to correct tomorrow since the doctor does her own coding and want to update her. Thank you.

 

[kbarron]

NH Medicaid does not want us to use 90461, we use 90460 U1 with the # of vaccines after the first one.

 

[Kar116]

Thanks for your reply. We are in AZ and they want the 90460, 90461.

 

[slik]

in PA, we don't use 90460 or 90461 either. Do you have a Medicaid rep that will help you figure out what they are looking for?

 

[shellysk8]

Helpful Link

Here is a link to helpful information specific to AZ Medicaid billing for VFC:

http://www.azahcccs.gov/commercial/ProviderBilling/rates/PCSrates.aspx

Thanks,
Shelly