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Other Qualified Healthcare Professional

  1. #1
    Overland Park, KS
    Default Other Qualified Healthcare Professional
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    When reviewing the coding changes for 2011, I have noticed that the new CPT codes for pediatric vaccine administration (codes 90460/90461) now have the terminology to say that they can be administered by a physician or "other qualified healthcare professional." I attended a workshop by the AMA earlier this month and they stated that these codes can only be used if the counseling is performed by a physician or mid-level provider (NP, PA), but the AAP seems to indicate that an RN can report these codes as well.

    My question is...what is the defintion of "other qualified healthcare professional?"
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  2. #2
    Dawson, we asked this very same of the AMA at the Chicago CPT convention in November and were told much the same answer as you (NP, PA). The AMA commented that there would be further clarification in future CPT Assistant bulletins early next year.

    However, the AAP. in their November coding newsletter gives the definition as "nonphysicians if allowed under state scope of practice." The same article also gives an example of 90460 not being appropriate when performed by a nurse "unless the particular state's scope of practice laws includes nurses within the definition of 'other qualified health care professionals'."

    Not much help, I know, but I guess the first place to look is your state's scope of practice regs.


  3. #3
    Overland Park, KS
    Thanks so much!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow

  4. #4
    Default CPT 90460 and 90461
    I need assistance in finding Washington State guidelines for Medical assistance. I informed my employer that MAs are not considered "other qualified healthcare professionals" however, reviewing the WAC codes, it doesn't state they are not qualified. An execuative decision was made and I don't agree.

    I need documentation to back up that MAs are not qualifed to counsel patients.

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