Wiki Vaccine coding

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Vaccine coding --HELP!!!!

If patient comes in and receives more than 1 vaccine in visit do i bill 90460 once or twice ???

 

[Knm5800]

90460 is to be billed once per each vaccine, as long as there is provider counseling involved.

ex: pt comes in for varicella and DTaP:
90716
90700
90460 x 2 (one for each vaccine)
90461 x 2 (DTaP is a 3 antigen vaccine, Diptheria, Tetanus and Pertusis)

90461 is for each antigen (disease) the immunization protects against.

Hope this makes sense.

 

[sbgill]

90460 is to be billed once per each vaccine, as long as there is provider counseling involved.

ex: pt comes in for varicella and DTaP:
90716
90700
90460 x 2 (one for each vaccine)
90461 x 2 (DTaP is a 3 antigen vaccine, Diptheria, Tetanus and Pertusis)

90461 is for each antigen (disease) the immunization protects against.

Hope this makes sense.

It really depends on the payer. The above example would be correct for commercial payers. For Georgia Medicaid however, as long as counseling is provided, you would bill a 90460 for the first vaccine and 1 unit of 90472 for each additional vaccine.

 

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Thank you!