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New CPT codes 90460 and 90461

  1. #11
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    Medical Coding Books
    It is my understanding that Tdap has three components( tetnasus deptheria, acellular pertusis), MMR has 3 componets( measles, mumps, rubella), etc. If anyone has another opinion it would be appreciated.
    Debbie Potts England
    Lyles, TN 37098

  2. #12
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    I understand how to use the new "90460" and "90461" but when would use "90471 and "90472"? Would that be for a flu clinic, where there is no counseling, patients just walk in and get the flu shot?

  3. #13
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    Quote Originally Posted by dburchett View Post
    I understand how to use the new "90460" and "90461" but when would use "90471 and "90472"? Would that be for a flu clinic, where there is no counseling, patients just walk in and get the flu shot?
    From what the AAP has published about the subject... yes you would use 90471-74 when there is no physician counseling. This also applies when a physician does not counsel for the additional vaccines in a series (HPV etc...)

    example if a physician documents that they personally performed the vaccine counseling on MMRV (4 components) you would bill for the vaccine, then code 90460 1 unit, 90461 3 units for the administration of the MMRV. If the physician does not document counseling then you can only code 90471 for the administration. This would greatly reduce your reimbursement on the administration of that vaccine.

    If a child is there for their second, third, etc in a series and the physician does not provide additional counseling then only a 90471-90474 can be coded.

    Also according to the AAP the appropriate way to code would be with units, so insead of 90460, 90461, 90461, 90461 you should code 90460, 90461 x3 units.
    Last edited by bhaskins1; 12-02-2010 at 03:17 PM. Reason: clarification
    Barbara Haskins CPC

  4. #14
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    Hi Debra, I am new to pediatrics billing could you give me an example of how to code these new Imm codes. I would really appericate it.

  5. #15
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    please contact me personally at dpotts@dicksonmd.com. I have something that I can forward to you.
    thanks
    Debbie
    Debbie Potts England
    Lyles, TN 37098

  6. #16
    Location
    Overland Park, KS
    Posts
    1,166
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    I just want to make sure that I understand....

    A 16-year old, established patient presents to the office with her mother for her annual exam. The provider orders the influenza and Tdap vaccines. The provider counsels the patient’s mother prior to the administration of vaccines, the counseling is documented in the chart, and the nurse administers the vaccines.

    Using these new codes, you would report:

    99394 (annul exam, established patient, ages 12-17)
    90658 (influenza vaccine, split virus)
    90460 (administration of influenza vaccine)
    90715 (Tdap vaccine)
    90460 (administration of first component of Tdap vaccine)
    90461 (second component of Tdap)
    90461 (third component of Tdap)

    If you were going to report in units, would you report?

    90658
    90460 X 1
    90715
    90460 X 1
    90461 X 2

    or

    90658
    90715
    90460 X 2
    90461 X 2

    Thoughts?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  7. #17
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    The 90460 is only listed once per claim. and you use them only if the patients( parents) were counselled about each component. it is less likely that happens when in is the second, third and fourth shot is a series. The doctor will need to document the counseling. then 90460 for the first componet and 90461 for each component there after even if there are multiple injections and each injection has multiple components. This is my interpretation of this so far.
    Hope it helps and if anyone has more informtion please share.
    thanks
    Debbie Potts England
    Lyles, TN 37098

  8. #18
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks so much Debbi!

    So in my example above, it should be reported as:

    90658
    90715
    90460 X 2
    90461 X 2

    Correct?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  9. #19
    Default
    I think it should be 90658, 90715, 90460 x 1, 90461 x 3 are you sure there was counseling in the flu vaccine? I have multiple and am rarely counseled. in that instance I would bill 90658, 90715, 90460 x1, 90461 x2, 90471. of course I don't have the CCI on this yet. I do have a print out from something some one sent me. If you send me an email to Dpotts@dicksonmd.com I will send it to you so you can look at it.

    thanks
    Debbie Potts England
    Lyles, TN 37098

  10. #20
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    Quote Originally Posted by debbiep View Post
    The 90460 is only listed once per claim. and you use them only if the patients( parents) were counselled about each component. it is less likely that happens when in is the second, third and fourth shot is a series. The doctor will need to document the counseling. then 90460 for the first componet and 90461 for each component there after even if there are multiple injections and each injection has multiple components. This is my interpretation of this so far.
    Hope it helps and if anyone has more informtion please share.
    thanks
    Debbie, I think the information above is incorrect. The 2011 CPT instructions (pg.450) state "Use 90460 for each vaccine administered. For vaccines with multiple components [combination vaccines], report 90460 in conjunction with 90461 for each additional component in a given vaccine."

    So for example, MMR (90707) and DTaP (90700) are given and physician provides vaccine counseling for all vaccine components, the vaccine and admin charges would be reported as follows:

    90707 - MMR
    90460 (measles)
    90461 x2 (Mumps, rubella)

    90700 - DTaP
    90460 (diphtheria)
    90461 x2 (tetanus, acellular pertussis)

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