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Please explain 90460 & 90461 example

  1. Default Please explain 90460 & 90461 example
    Medical Coding Books
    Can someone explain why you would use procedure code 90461 instead of 90460 for the pneumococcal vaccine in the following example taken from the AAP Coding for Pediatrics 2011 book?

    Example: A child was given and counseled on the DTaP-Hib-IPV, rotavirus, and pneumococcal vaccines.

    1. 90698 (DTap-Hib-IPV)
    -90460
    -90461 x 4 units

    2. 90480 (Rotavirus)
    -90460

    3. 90669 (Pneumococcal)
    -90461

    Thank you for your help!

    -Stacy, CPC

  2. #2
    Default
    After reading a bunch of information including coding examples on the AAP's site, I think the above example is a misprint. The Pneumococcal isn't a component of the 90698 or the 90480, so I'm pretty sure a 90460 would be used on the 90669.

    I'd certainly be interested in hearing from anyone else who thinks differently.

    Becky, CPC

  3. #3
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    Kansas City Chapter
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    Default
    I agree that this is probably a misprint also after reading the Coding for Peds 2011 book as well as the AAP pediatric coding newsletter November 2010 Volume 6 #2 issue which also gives additional examples on how to use these new codes.

  4. #4
    Location
    Greeley, Colorado
    Posts
    2,045
    Default
    Quote Originally Posted by KERRIEA View Post
    I agree that this is probably a misprint also after reading the Coding for Peds 2011 book as well as the AAP pediatric coding newsletter November 2010 Volume 6 #2 issue which also gives additional examples on how to use these new codes.
    Hi - wondering if there is any way I could get a copy of one of these examples?
    Thanks
    Lisa Bledsoe, CPC, CPMA

  5. Default
    I would very much like to have the description of the codes 90460 and 90461. Sorry, because the manual I have at present is that of 2009.

    But the one 90669 I understand is for PCV- Conjugate vaccine.

    What I know of its importance , shall I give, with your kind permission:

    The two killer organisms Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae are the leading causes of pneumonia types and so the birth of two relatively new vaccines, Hib conjugate vaccine (HibCV) and pneumococcal conjugate vaccines (PCVs).

    Pneumococci are CAPSULATED organisms. S. pneumoniae is a gram-positive diplococci with a polysaccharide capsule that helps protect it from host defense mechanisms. Ninety capsular serotypes have been identified.

    It is rationale to select PCV over PPV because "Conjugated vaccine" provide better immunological sero-protection for the children of 2yrs and below, whose immune system does not provide adequate immunological barrier for these capsulated organism.

    PPV is selected for older kids and adults (of certain high risk groups).
    Hence PCV code 90669 makes sense for younger children of 2years and under, which is mandatory.

    I do not know whether this helps.
    Thanks for listening.

  6. Default
    And of course as Becky said, the IPV in the code 90698 stands for Inactivated P oleo Vaccine and not Pneumo.
    Thank you

  7. #7
    Unhappy Ack!
    OK, so I thought I got these new admin codes and now I am not so sure.....
    I am unclear as to billing the new counseling admin codes when there are multiple vaccines involved.
    Example:

    90670 - Prevnar 13 (1 component)
    90723 - Pediarix (5 components)
    90645 - HIB (1 component)
    Counseling done on all vaccines.

    In 2010 we would have billed:
    90465 x 1
    90466 x 2
    90670, 90723, 90645

    In 2011, would we be billing
    90460 x 1
    90461 x 6
    90670,90723,90645

    OR

    90460 x 1
    90670
    90460 x 1
    90461 x 4
    90723
    90460 x 1
    90645

    The 2011 CPT description for 90461 reads "each additional vaccine/toxoid component" so I would think that meant additional components whether the same or another vaccine but I am being told that is incorrect.

    Can anyone tell me which scenario is correct? And if you know of any documentation to back it up I would also greatly appreciate it!

    Thanks so much!!

  8. Question 90460, 94601
    can some one please explain to me this question .
    A 15 month old is brought to his physicians office for DTaP injection. His mother receives physician counseling.
    and the answer being 90700, 90460, 90461x2.....
    im not following as to why the 90461 was added and then x2

  9. Default
    Quote Originally Posted by jenmarenyi View Post
    can some one please explain to me this question .
    A 15 month old is brought to his physicians office for DTaP injection. His mother receives physician counseling.
    and the answer being 90700, 90460, 90461x2.....
    im not following as to why the 90461 was added and then x2

    Think of it this way:
    90460- administration/counseling on the Diphtheria
    90461- administration/counseling on the Tetanus
    90461- administration/counseling on the Pertussis

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