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Wiki Vaccines - Please advise how a biller

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pellison

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Please advise how a biller should be billing 90698; 90680 and 90670 all total 7 components. We are being told that the administration codes are as follows: 90460x3; and 90461x4. I believe that this should be billed as follows: 90460x1; 90461x5 and 90473x1. Please advise.

Thank you very much!

Pat Ellison, CPC
 
I believe this should be coded as
90460 x 2 (for 90698 & 90670)
90461 x 4 (for the 4 additional toxoids cpt 90698)
90474 x 1 for the oral (90680) and you don't use 90473 (see paranthetical note)

Very confusing, we had a lot of issues last year with 90473 and 90474.
 
it depends - are patients under or over the age of 18?

does provider or other qualified health professional counsel patients or patient's parents?

90460x3; and 90461x4 - this would be correct if the child is under 18 and a qualified health care professional counseled patient and/ or patients caregiver AND DOCUMENTED it.

90460/90461 can be used regardless of administration and with counseling.
 
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