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Thread: Flu Mist and other vaccines

  1. #1
    Join Date
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    Default Flu Mist and other vaccines

    Promo: Code Books
    How do you get the nasal flu coded and paid with other vaccines on same day? Everything I am reading makes it look like itis not billable....Thanks in advance
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  2. #2
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    Grand Rapids, MI
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    We bill an admin code of 90473 and a serum code of 90660 and have no problem getting reimbursement.

  3. #3
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    We have emdeon as our clearing house and the edit says " 90460 and 90473" procedure combo not sep payable...I tried pointer to add flu dx and still the same edit.
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  4. #4

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    Karen,

    Per the NCCI Edits, you can't report codes 90460/90461 and 90471/90473 together. You have to report codes 90472 or 90474 for additional vaccines.

    My question here is: code 90460 is for pediatric patients ages birth -18 years of age when counseling is provided prior to the vaccine administration. From what I read in your post, are you administering more than one vaccine and counseling on one and not the other?

    As I see it, you have a couple of options:

    1. If this is a pediatric patient (ages birth -18 years of age) and you are administering the flu vaccine only and counseling is being provided prior to the vaccine administration, you only report code 90460 as this code includes any method of administration.

    2. If this is a pediatric patient (ages birth -18 years of age) and you are administering the flu vaccine (intranasal as your post seems to indicate) in conjunction with another vaccine and you counsel the patient on one vacicne, but not on the flu, the coding then would look like this: 90460 for the first vaccine and 90474 for the flu vaccine.

    I hope this helps here and this is my opinion
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  5. #5
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    pt had DTap, IVP MMR/VAR along with the flu mist 90460 x1 and 90461 x6 (each component) 90660 w/90473.. I have been away from pediatric coding for awhile...thanks...
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  6. #6

    Default

    Actually, the coding would look like this:

    90460 X 3
    90461 X 5
    90474

    90460 is reported for each vaccine given or the first component of a combination vaccine. 90461 is added for each addtional component.

    Dtap has three components, Diphtheria=90460 X 1, tetanus=90461 X 1, and polio =90461 X 1.

    IPV is a single vaccine=90460 X 1

    MMRV has four components, measles=90460 X 1, mumps=90461 X 1, rubella=90461 X 1, and varicella=90461 X 1

    Flu mist=90474

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

  7. #7
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    Thank you very much for this information. Is there a website reference point where I can prove this?
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  8. #8

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    I am using the CPT Manual as the source. I am referencing the Professional Edition, page 450. This guidance is located under the description of codes 90460/90461. It is in green lettering.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P
    Compliance Auditor

  9. #9
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    Quote Originally Posted by dballard2004 View Post
    I am using the CPT Manual as the source. I am referencing the Professional Edition, page 450. This guidance is located under the description of codes 90460/90461. It is in green lettering.
    That's why I call you " Awesome Dawson"!
    Roxanne Thames CPC, CPC-I, CEMC
    rthamescpci@gmail.com


    "Remember the greatest gift is not found in the store but in the heart of true friends"

  10. #10
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    OK with that said, I went to page 451 and it says "Separate codes are available for combination vaccines (eg DTP-Hib, Dtap-Hib, HebB-Hib) It is inappropriate to code each component of a combination vaccine separately.".
    Karen Barron, CPC
    Hampton New Hampshire Chapter

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