Wiki When to use the 90465-90468 code range

[maryanneheath]

I need help to understand when to exactly use the 90465-90468 face-to-face physician code when administering a vaccination? Is it only when the physician counsels the patient/family, or is it used for age appropriate even if no face-to-face is done?

When a doctor sees a child for a well child exam and orders a vaccination, is this considered face-to-face and qualify for a 90465-90468. What documentation is required to choose between a 90465-90468 and a 90471-90474?

 

[Lliza71]

90465-90468 ranges

the 90465-90468 range is to be used for anyone younger than 8 yrs old. The 90471-90474 range is to be used for anyone 8 yrs or older.

If your doc does a well exam and gives a 5 yr old child a vaccine, this is face-to-face, and you would bill the 90465 range.

If your doc does a well exam and gives a 10 yr old child a vaccine, this is face-to-face and you would bill the 90471 range.

Here's the catch.... Say a 5 yo pt comes in for vaccine only and has no exam done. The doc walks in the room, says hello, gives the vaccine, and the pt is in & out w/in 5 mins. NO EXAM, NO COUNSELING. You would then bill the 90471 range even though the pt is under 8 yrs old. That's because the 90465 range requires face-to-face and no FTF was done.
For FTF, you'd need documentation of some kind of visit or of the time the Dr is interacting w/pt. (Dr. documents pt's CC if any, or review of systems, or
something of that nature). Maybe someone else could help a little better w/the definition of FTF, better than I can.
Hope this helped you somewhat.
Liza