I'm basing my answer on an AAP Coding newsletter from November, 2010, where they give a similar scenario: MMRV with counseling (90460) and DTaP-IPV (90696) without counseling (90472). In the same article the AAP also says "There are no current CPT guidelines restricting the reporting of codes 90471 - 90474 in conjunction with codes 90460 and 90461."
It would be interesting to see what payers would do with this scenario.
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