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90471 & 90472 adm fees

  1. Default 90471 & 90472 adm fees
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    How should one code for injections when the provider does 4 immunizations and one of them is not eligible for benefits? My doctor did Hep A, Hep B, Dtap and Polio and the payor allowed all but the Hep A because it needed a PA. We billed 90741 for the first shot and then 90472 with 3 units for the 3rd shot. Is that correct? Or should they all have been 90471? The payor denied the 3 unit charges then we got them to be reprocessed but they unbundled the 90472 and allowed 2 of the adm fees and denied the other one due to no PA. Is that correct for billing and for payor processing? Any thoughts out there?

    Thanks!

  2. #2
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    Quote Originally Posted by wannabecoder View Post
    How should one code for injections when the provider does 4 immunizations and one of them is not eligible for benefits? My doctor did Hep A, Hep B, Dtap and Polio and the payor allowed all but the Hep A because it needed a PA. We billed 90741 for the first shot and then 90472 with 3 units for the 3rd shot. Is that correct? Or should they all have been 90471? The payor denied the 3 unit charges then we got them to be reprocessed but they unbundled the 90472 and allowed 2 of the adm fees and denied the other one due to no PA. Is that correct for billing and for payor processing? Any thoughts out there?

    Thanks!
    Don't use 90471 unless they're over 18, or there was not any kind of counseling done. Use 90460 for every shot given, and for combination vaccines (Like dtap), also bill one unit of 90461 for each additional component of the vaccine. Example:
    DTaP:
    Diptheria - 90460
    Tetanus - 90461
    Pertussis - 90461
    Check with the payer to see how they want you to bill those - some want for you to lump them all together, and some don't. Hope that helps!

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