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Thread: Well Child Visit & Immunizations

  1. #1

    Thumbs up Well Child Visit & Immunizations

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    Can someone tell me if childhood immunizations are included in a well child visit or if they are paid seperately? I thought they would be paid seperately but want to make sure. Also would you bill the drug, admin fee and well child visit? Or would you just bill the drug and well child visit?
    Thanks!

  2. #2

    Default Child visit and Immunizations

    As far as I know from working in PEDS. The Immunizations are billed separating. Depending on the type of Insurance is the actually cost of the immunization.

  3. #3
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    you can bill the immunizations separately - append a modifier .25 to the preventive service office visit. Yes, you charge the administration fee also - 90471 for the initial immunization given and 90472 for any others (depending on how many are given). Some insurances do not pay for the immunization as the suppoly is given by the State and considered "free", for - Medical Assistance and PMAP program immunizations are "free", we have to append the .SL modifier to them. We are reimbursed for the adminstration of them.
    {that's my opinion/advice on the posted matter}
    Donna, CPC, CPC-H

  4. #4

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    You bill the well child visit, the drug administered and the admin. fee....depending upon the number of immun. admin. you use the add on code for additional immun. Don't forget to see if the drug was administered orally or intramuscular there are separate ones for that.


    Allison Hudson, CPC

  5. #5
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    Quote Originally Posted by AllisonH View Post
    You bill the well child visit, the drug administered and the admin. fee....depending upon the number of immun. admin. you use the add on code for additional immun. Don't forget to see if the drug was administered orally or intramuscular there are separate ones for that.


    Allison Hudson, CPC
    Don't forget if they are under 8 to use 90465/90466 if counseling was done.
    Last edited by kbarron; 08-06-2008 at 11:29 AM. Reason: add wording
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  6. #6
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    If an oral/intranasal immunization is done in conjunction with IM, be sure to use 90474 (as subsequent to the initial 90471).

    kbarron - Aren't the counseling immunizatino administration codes only used if there is not a WCC? Because "counseling" is part of the preventive code? Just curious how others view these counseling codes...

  7. #7
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    Default Immunizations

    [QUOTE=Lisa Curtis;20804]If an oral/intranasal immunization is done in conjunction with IM, be sure to use 90474 (as subsequent to the initial 90471).

    kbarron - Aren't the counseling immunizatino administration codes only used if there is not a WCC? Because "counseling" is part of the preventive code? Just curious how others view these counseling codes... [/QUOTE

    Lisa:My understanding is that vaccine codes are separate from the WCC, and when done at the WCC, can use 90465/90466...Look forward to the buzz about this topic...
    Karen Barron, CPC
    Hampton New Hampshire Chapter

  8. #8
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    2017 ICD-10-CM Coding Book
    Karen -
    Here's my thought process: Preventive Med codes include "counseling/anticipatory guidance/risk factor reduction intervention"; code 90465-90468 are reported "only when the physician provides face-to-face counseling of the patient and family during the administration of a vaccine." Seems like using both might be double dipping into the counseling...just my opinion.

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