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Thread: How to code for injections/vaccination

  1. #1
    Join Date
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    Default How to code for injections/vaccination

    I am new to the arena of walk in clinic coding and the injections & vaccinations are getting the best of me.

    When administering standard pediatric vaccinations, what is the correct injection code to use?

    J codes are drug codes correct?

    If ANYONE has some insight to this injection coding thing, I would appreciate it. I need to get it down in my head correctly.

    Thanks for any help in this area.

  2. #2
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    Default

    Peds vaccination there is no J code. It is only CPT codes along with Administrative codes (Usually 96372 for IM/SQ).If patient has fever or other illness and they administer any injections then use J codes along with administration codes

  3. #3
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    Default

    Quote Originally Posted by kumeena View Post
    Peds vaccination there is no J code. It is only CPT codes along with Administrative codes (Usually 96372 for IM/SQ).If patient has fever or other illness and they administer any injections then use J codes along with administration codes
    Vaccination administration codes are not 96372 that is for therapeutic, Vaccination admin codes are in the range 90465-90474 depending on age. Plus the code for the toxoid.

    Debra A. Mitchell, MSPH, CPC-H

  4. #4
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    Default

    Thank you both for the clarification on the pediatric vaccine codes HOWEVER what about a patient that comes in and needs a "monthly" injection for a condition (I cannot think of a drug name off the top of my head as I haven't been doing this long) it will be a J code and do I also use the 96372 code for injection or does it also fall under the 90465 90472 classification?

    What about the Depo shot? That is all the patient came in for. How is it coded?

    And multiple injections? lets say there are three injections given and one oral. Do I code the first injection 90471 and 90472x2 ????

    Thanks for all the help.

  5. #5
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    Default

    What kind of monthy injection? There are admin codes for vaccines, therapeutic, or allergy. Depo is the J code with the 96372 for the admin. multiple injections again what kind? If you are using the 90471 for the first vaccine the then 90472, followed by the 90472 -59 is the more appropriate way to list them. I know some do use units but to list each separate vaccine is the better way in my opinion.

    Debra A. Mitchell, MSPH, CPC-H

  6. #6
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    Red face

    Just be careful that 90465 - 90468 are only used when a physician provides face to face counseling along with the vaccination. (for patients under 8 years old, also...) You would use the vaccine/toxoid admin codes 90465 - 90474 if the injection is for an actual vaccine or toxoid product, which are listed as CPT codes listed a little bit after 90474. (Like Varicella Vaccine, 90716, or influenza vaccine, 90658). If multiple vaccines are being given, only list 1 "first vaccine" code (one with an odd# - which one depends on the method of administration, either shot, or oral/nasal), and all the rest are the subsequent "each additional" codes. For most commercial payers, no modifier is required to list multiple vaccines. If you're injecting something else - like a drug that requires a J-code (Rocephin, J0696, for example), then you would use 96372. I would suggest appending 96372 with a 59 modifier if you're billing it along side vaccine administrations for commercial insurance. If you bill multiple 96372's, it's better to bill them out as separate single unit line items, and use 59 modifiers on all of the extra ones (after the first 96372). Otherwise they might deny as "exceeding typical daily frequency". If you bill a 96372 with an office visit, there are 2 things to always remember: 1. you can't bill a 99211 with a 96372. 2. Any other E/M code will require a 25 modifier to keep it from bundling to 96372. We see a ton of denials that pertain to this issue on the follow up side, but 9 times out of 10, it's an easy fix...hope that's helpful!

  7. #7

    Default Beth Sonnier cpc

    Thanks I learned alot in your synopsis!

  8. #8

    Default Medical coder

    CPT specifically instructs you to "do not report 96372 for injections without direct physician or other qualified health care professional supervision. To report, use 99211. Hospitals may report 93672 when the physician or other qualified health care professional is not present."

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