Vaccine administration

natraj21

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Hi,

18 month old came for vaccination and check up. Physician has documented the diagnosis as

1. 474.12 hypertrophy of adenoids alone
V03.82 Vaccination and inoculation; streptococcus pneumoniae [pneumococcus]
V06.8 Vaccination of combined diseases; vaccination of; other combinations

and has given the physician notes as:

The patient needs were assessed, there is no educational barrier. Patient received Education on Safe and effective use of all Medication taken, including potential medication side effects..

In this situation can we code 90460 and 90461 for vaccination?
Can we consider this Physician notes as Counsiling to code 90460 and 90461 which is needed to code?
Can we code 90460 and 90461 with E&M?

Please guide me through this..

Thanks in advance
Natarajan Chellamuthu, CPC
 

ollielooya

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From the notes presented looks like patient just presented for the vaccinations with the expected counseling component, but like Debra, see nothing that would warrant assigning an EM code even though the 474.12 hypertrophy of adenoids alone were mentioned. But that's all...only mentioned and not addressed, therefore no EM needed..
 

natraj21

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Hi,

Thank you for your valued reply, In some situations where there is another complaint to code and there is documentation of History, PE.
How should be the documentation to code 90460-61 with E&M in above circumstance?
Because there is need for the risk factor counseling with parents or relatives since the code is for the less than 8 years age.

Thanks in advance

Natarajan Chellamuthu, CPC.
 

ollielooya

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Again, and depending if there is a another complaint that is addressed separately (not just the visit for the vaccinations), it is my understanding that an EM would be appropriate to add with the modifier 25. Others will correct me if I am wrong. Additionally since the instructions at the beginning of codes 90460 and 90461 require that face to face physician counseling be included, and if your notes support that, you have what you need for those two codes. CPT states: "if a significant separately identifiable E/M service (eg. office or other outpatient services, preventive medicine services) is performed, the appropriate EM service should be reported in addition to the vaccine and toxoid administration codes. So an EM would be allowable.

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natraj21

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Again, and depending if there is a another complaint that is addressed separately (not just the visit for the vaccinations), it is my understanding that an EM would be appropriate to add with the modifier 25. Others will correct me if I am wrong. Additionally since the instructions at the beginning of codes 90460 and 90461 require that face to face physician counseling be included, and if your notes support that, you have what you need for those two codes. CPT states: "if a significant separately identifiable E/M service (eg. office or other outpatient services, preventive medicine services) is performed, the appropriate EM service should be reported in addition to the vaccine and toxoid administration codes. So an EM would be allowable.

Is this what you're looking for?
Hi,

Yes, thank you for your useful information. Thanks a lot..
 

lburke31

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Did the child receive meds for adenoids? Regardless, a medication is a medication and a vaccine is a vaccine. I would not code counseling for what your md documented. 90471 and 90472 + well. Lburke cpedc
 
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