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Thread: Advice needed for vaccination billing

  1. #1
    Join Date
    Apr 2007
    Posts
    20

    Question Advice needed for vaccination billing

    Promo: Code Books
    As new codes 90460, 90461 replaced 90465~8 starting 1/1/2011, we've got some confusion about the right way to bill immunization in the pediatric office. For instance, to bill immunization for PEDIARIX,Hib,Rota, we have option A or B. Which is right? (our billing system only allows 6 lines for cpt codes).

    Advice(s) will be greatly appreciated.
    Bamboo

    Option A

    icd: 1. v06.8, 2. v03.81, 3. v03.82, 4. v04.89
    cpt
    90723
    90460 (3 units)
    90461 (4 units)
    90471
    90648
    90669
    90472(2 units)
    90680
    90473


    Option B
    icd: 1. v06.8, 2. v03.81, 3. v03.82, 4. v04.89

    cpt
    90723
    90460
    90461 (4 units)
    90471
    90648
    90460
    90472
    90669
    90460
    90472
    90680
    90460
    90473

  2. #2
    Join Date
    Apr 2007
    Location
    Greeley, Colorado
    Posts
    2,046

    Default

    Here is what I understand for the coding of Pediarex (DtaP-HepB-IPV), Hib, Rotavirus:
    90723 (Pediarex) V06.8
    90460
    90461 x2 (3 components total for Pediarex)

    90468 (Hib) V03.81
    90460 (one component)

    90680 (Rota) V04.89
    90460 (one component and the definition states "any method")

    90460-90461 can only be reported if physician counseling as described in CPT is provided and the patient 18 or younger.

    I hope someone will review this so I know if I'm doing it right.
    Lisa Bledsoe, CPC, CPMA

  3. #3
    Join Date
    Apr 2007
    Location
    Lakeland, FL
    Posts
    25

    Default

    We are billing it as indicated in Option A:

    90460 x the # of units
    90461 x the # of units

    I did see the recommendations from the American Academy of Pediatrics to bill it out on every line as you indicated in option B, but I could not find any quidelines stating we can not bill with multiple units.

    We are going to monitor to make sure we are being reimburse for all admin of injections.

    Also keep in mind if the patient is being seen for a WCC, then you can solely us V20.2 and not the individual codes. We are not experiencing any difficulty from our payers when billing in the manner.

    Deanna

  4. #4
    Join Date
    Apr 2007
    Posts
    20

    Default

    Thanks Lisa and Deanna, for your quick response and advices. I'll do some claims in option A and some B, and see what happen to the reimbursement.

    Deanna, when you said that "if the patient is being seen for a WCC, then you can solely use V20.2 and not the individual codes", what did you mean?

    Bamboo
    Last edited by Bamboo; 01-12-2011 at 12:05 PM.

  5. #5
    Join Date
    Apr 2007
    Location
    Lakeland, FL
    Posts
    25

    Smile

    When they are being seen for their Well Child Check or Well Child Visit (preventative visit) you can use V20.2 linked to all the vaccines and admin codes.

    Now keep in mind it is Carrier specific so they may require both V codes. But we have never run into an issue solely using V20.2

    Hope this helps!
    Deanna

  6. #6
    Join Date
    Apr 2007
    Posts
    20

    Smile

    Wow, that will make things much easier without the complicity of listing and corresponding all the icd codes for every vaccine! I'll experiment with some of our claims to see if this works with our payers.

    By the way, I've found a very good website where they listed all the immunization coding, here l'd like to share with you: http://practice.aap.org/content.aspx?aid=2334


    Bamboo

  7. #7
    Join Date
    Apr 2007
    Location
    Lakeland, FL
    Posts
    25

    Default

    Hope everything works to your favor!!! Good luck!

    Deanna

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