Caroline - This was a topic at the AMA conference this year. The presenters at the AMA's CPT Symposium went into a fair amount of detail on the correct usage of these codes. These new codes are only to be used when counseling is done with the vaccine. The provider must be a mid-level (NP, PA, etc.) or above. An RN etc are not considered "providers".
Originally Posted by caroline
The documentation needs to state the provider counseled on the specific vaccine and the risks/benefits of that vaccine. A statement like "Pt was counseled on risk and benefits" is not enough.
The counseling codes would be billed for each vaccine in which counseling is performed and documented. For example, the patient receives one injection of the MMR vaccine. The provider counsels and documents the risk/benefits of the measles vaccine, the mumps vaccine, and the rubella vaccine. The counseling codes would be used three times.
If the vaccines were given and no counseling was provided and documented, these codes woult not be used. I hope this is helpful
Happy Coding, Claudia
Claudia Yoakum-Watson, CPC
Coding, Compliance, & Reimbursement Solutions
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