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Which one is the add on code? 90471 and 90746

P

pvang

Networker
Messages
91
Location
Appleton, WI
Hi all,

Can anyone tell me which one is the add-on code and which one is the primary code for 90471 (immunization adm) and 90746 (hep B vaccine)?

Thanks!

Pvang
 
more info

The system that we have is listing that both of these codes are primary to each other, which I find that kind of odd since the possible coding relationships are unbundling, mutually exclusive, or none if both are primary codes. I feel like I should know this but I'm not able to get a firm grasp on a solid answer here. Thanks in advance for the help. :confused: :)
 
90471

90746 is hep b adult dosage so 90471 is code used for shot admin. If you do a second shot then 90472 is the each additional shot code unless you are giving oral/nasal vaccines then you use those codes (90467 1st 90468 each addtl under 8, and 90473 1st 90474 ea addtl over 8). Hope that helps! :d
 
HBULLOCK said:
90746 is hep b adult dosage so 90471 is code used for shot admin. If you do a second shot then 90472 is the each additional shot code unless you are giving oral/nasal vaccines then you use those codes (90467 1st 90468 each addtl under 8, and 90473 1st 90474 ea addtl over 8). Hope that helps! :d
Click to expand...

Besides the add-on codes for vacc admin itself, what is the coding relationship between administration codes and the vaccination codes? Our claims scrubbing system has them listed as both primary codes to each other. I'm trying to locate the rationale for this code relationship if anyone knows of one. Thanks.
 
The Vaccine 90746 is the actual serum that you are using and the administration 90471 is the act of giving the injection so they are both primary with no bundleing, it is the same as a 96372 with a J code for the drug.
 
Can I find that piece of information somewhere on paper?
I need something to verify that both administration codes and the vaccination codes are both primary and not add-on codes to each other. If what the system is telling me is incorrect then I would need to forward this to their attention, but I want to make sure I am armed with the documentation that supports this. Thanks.
 
I am not sure what you are looking for the term add on does not apply to this scenario. Add on codes are designated in the CPT book and indicate when one procedure is always performed initially and the second procedure cannot be performed with the first one having been performed.
You have two different things here you have a serum which goes into a syringe and you have the administration of that serum. For every administration there is a substance and for every substance there is an administration. They are not "add on" to each other they work in conjunction to one another. The 90471 is the primary administration of the 90476 primary substance. IF you had two vaccines to administer then you have two substances and you would have 2 administrations, but the way the AMA structured this section, instead of coding the 90471 twice, they designated it as the INITIAL administration of a substance and 90472 as an ADD ON for each additional administration. There is nothing anyone can provide you in writing to prove this.
 
Thank you!

Thanks to all for your responses! And Mitchellde, you explained it very clearly. I'm working with a new claim scrubbing software that we are in the process of implementing, and their database has the admin codes linked to vaccination codes as both a "Primary Code" and an "Add On Code" and vice versa. I could see no way how one or the other could be considered solely as the 'primary' or as the 'add on code' since it can be individually billed with other adm code or vaccination codes.This had me confused and I wanted to hear what the rest of the coding community thought about this. I had a nagging feeling that I wasn't really missing out on anything big here, but I just wanted to confirm this.
..... Then finally it hit me that maybe the reason why they had it set up this way was because both codes from the admin codes and the vaccination codes have to both be billed not just one or the other and this was just their way of capturing this coding relationship. :p I know it took me a while but now I got it! Thanks ;)
 
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