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Thread: 90471

  1. #1
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    Default 90471

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    I am billing for Pediatrics and my claims keep getting bounced out when a patient sees the nurse for immunizations. I am billing each vaccine with a 90471 admin code, however I keep getting error messages that 90471 can only be used once on a claim. Does anyone know if this is true, or should I contact the payor?

  2. #2

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    Marissa,

    This is true. Per the CPT guidelines, 90471 is used for the first administration of a vaccine given IM. If you are reporting addtional vaccines given IM, you report code 90472 for each addtional vaccine you give.

    90472 is an add-on code and can only be reported in conjunction with code 90471.

    If the vaccines are given via the oral or intranasal route, take a look at codes 90473/90474. If the vaccines are given to a pediatric patient (age 0-18) and counseling is done prior to the vaccine, take a look at codes 90460/90461.

    Hope this helps.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  3. #3
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    Default

    Quote Originally Posted by marissa487 View Post
    I am billing for Pediatrics and my claims keep getting bounced out when a patient sees the nurse for immunizations. I am billing each vaccine with a 90471 admin code, however I keep getting error messages that 90471 can only be used once on a claim. Does anyone know if this is true, or should I contact the payor?
    It is true - when using 90471 - 90474, you go by the number of physical administrations given - the odd # codes are for the first vaccine, and all additional vaccines administered have to be reported with even # codes, depending on the route of administration. So, if you have 2 shots and one nasal admin, you could bill it either of these ways:
    90471(initial admin, IM), 90472 (additional admin, IM), 90474 (additional admin, oral or nasal) or 90473 (initial, oral or nasal), 90472, 90472
    *Just remember that a vaccine can only be "initial" (or first) once - everything after that is subsequent. This is completely backwards from the new admin codes 90460 and 90461, which are based on the number of vaccine component products administered. If you have any other questions, please let me know! Hope that helps!

  4. #4
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    NYMAC
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    Default

    Quote Originally Posted by marissa487 View Post
    I am billing for Pediatrics and my claims keep getting bounced out when a patient sees the nurse for immunizations. I am billing each vaccine with a 90471 admin code, however I keep getting error messages that 90471 can only be used once on a claim. Does anyone know if this is true, or should I contact the payor?
    Yes. you can use 90471 once per day and use 90472 for each additional vaccine

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