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