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Documentation for 90465

  1. #1
    Question Documentation for 90465
    Medical Coding Books
    What are the requirements for this code?

    My understanding is the physician would have to counsel the patients on benefits, risks, and possible side effects of the vaccine. So it stands to reason the documentation should show this is what happened. Is it ok to have a check box stating handouts were given? I don't feel that is enough to support this but I want to give them the benefit of the doubt, nobody wants to do document anymore than necessary.

    I also don't think this should be billed if the info was given by the nurse. Since it states physician, I don't see how this could be billed incident to either.


    Laura, CPC, CEMC

  2. #2
    North Carolina

    CPT Assistant provided a vignette for this code...

    Clinical Example for Code 90465

    The physician first reviews the patient's previous experience with the vaccine and determines if there are any contraindications prior to proceeding. A vaccine information sheet (VIS) is given to the parent or guardian for the DTaP vaccine, and, in keeping with state and federal laws, the information including risks and benefits of DTaP vaccine is discussed with the parent or guardian in detail. A discussion also occurs about the vaccine and the diseases it protects against. Appropriate documentation is entered into the patient record.

    The documentation for the vaccine includes which VIS was given; the date of the publication of the VIS; the date the VIS was given; the name, address, and title of the person who administered the vaccine; the date of administration; the vaccine manufacturer; and the vaccine lot number. Additionally, the appropriate types and doses of medications to alleviate fever and pain at the injection site are discussed. Since the physician participates in the Vaccines for Children (VFC) program, the nurse obtains the vaccine from the appropriate inventory, documenting which supply of vaccines was used for this particular patient. Although federal law does not mandate separate vaccine inventories, the Centers for Disease Control and Prevention (CDC) strongly recommends them for reasons of accountability. Informed consent is obtained by the physician who then orders the nurse to prepare the vaccine. The nurse prepares and administers the DTaP vaccine using a safe, sharp syringe. After observing the patient in the office for an immediate allergic reaction, the patient is discharged home by the nurse. The immunization tracking number is entered into a computerized statewide registry.

    And you are correct...90465 is for physician counseling. CPT Assist states it's appropriate to use code 90471 when the provider does not provide counseling.
    Last edited by RebeccaWoodward*; 09-10-2009 at 07:50 AM.

  3. #3
    Thanks Rebecca.

    Another question, do some insurances pay more for 90465 than they do 90471? I assumed they did since there was a separate code, now I'm not so sure. It looks like medicare pays the same for both codes. Granted not many patients that qualify for 90465 have medicare but some do.


    Laura, CPC, CEMC

  4. #4
    North Carolina
    I wish I could tell you for certain. Since we do not have peds, our children population is very small.

  5. #5
    Greeley, Colorado
    I believe these codes carry the same RVU's...
    Lisa Bledsoe, CPC, CPMA

  6. Default
    charges for the codes 90465 and 90471 are the same, however re-imbursement from insurance companies is higher with the 90465

  7. #7
    Default VFC vaccine administration
    This question is kind of related to this topic. Please help.
    My name is Anu. I work for a pediatritian.
    We accept Americhoice insurance. But the insurance would not pay for vaccination administration when it is covered under VFC program (even with modifier SL). But on their web site they say they do reimburse the amount. What do I do to collect money from the insurance.
    Thank You.

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