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90460 + 90461 with multiple vaccines

  1. #1
    Question 90460 + 90461 with multiple vaccines
    Medical Coding Books
    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.

    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


    90460 x 1
    90460 x 1
    90461 x 4
    90460 x 1

    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!!

  2. #2
    The second scenario is correct. You need 90460 with each initial component. When the vaccine has multiple components you bill 90460 for initial component then 90461 x #addtl components.

  3. #3
    Default Thanks!!
    Thanks Helen! I appreciate the response.
    These new codes are killing me! It's been so hard to explain to the docs and now it'll be even more fun!
    Have a great day,

  4. #4
    Lakeland, FL
    I agree they are confusing, but I marked the appropriate admin codes above the vaccine in my CPT book to help me down the line.

    Good luck!

  5. Question 90460 Documentation

    Can anyone tell me what type of EMR documentation is necessary? Is it enough documenting the patient was given the VIS form or does the physician have to actually document he counseled the patient/parent?

    I'd really appreciate any response.


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