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Immunization billing question

  1. Default Immunization billing question
    Medical Coding Books
    Hey everyone,

    I am new to pediatric billing and Im a bit confused on a coding issue. I know to use 90460-90461 for admin under 18 with face to face counseling. And to use 90471- 90472 is pt is over 18yrs and no counseling.

    Question is what admin code would I use if the patient is under 18yrs and there was no counseling offered, the MD. gave the shot but no counseling.

    Help thank you!

  2. #2
    Default
    Quote Originally Posted by cecilia73 View Post
    hey everyone,

    i am new to pediatric billing and im a bit confused on a coding issue. I know to use 90460-90461 for admin under 18 with face to face counseling. And to use 90471- 90472 is pt is over 18yrs and no counseling.

    Question is what admin code would i use if the patient is under 18yrs and there was no counseling offered, the md. Gave the shot but no counseling.

    Help thank you!
    90471-90472


  3. Default
    Thanks Brandi,

    So the codes 90471-90472 are also used for patients under the age of 18, if Im understanding this correctly. The description the ICD 9 gives only states above 18yrs old. Thank you for helping me out on this I was going nuts trying to figure out another code.

  4. #4
    Default
    Quote Originally Posted by cecilia73 View Post
    Thanks Brandi,

    So the codes 90471-90472 are also used for patients under the age of 18, if Im understanding this correctly. The description the ICD 9 gives only states above 18yrs old. Thank you for helping me out on this I was going nuts trying to figure out another code.
    Yes, that's correct. The guidelines (in green) on page 458 of the CPT instruct you to use 90471-90474, for patients who are over 18, or when no counseling is provided with pediatric patients. Hope that helps!

  5. Default
    Yes it does you are a life saver. Now I have one other question. I am trying to bill code 90657 where can I find a list of # of components this vaccine and others have so I can make sure I am billing the correct # . Thanks again Brandi

  6. #6
    Default
    Quote Originally Posted by cecilia73 View Post
    Yes it does you are a life saver. Now I have one other question. I am trying to bill code 90657 where can I find a list of # of components this vaccine and others have so I can make sure I am billing the correct # . Thanks again Brandi
    I'm not sure if there is an official list, but if I had to guess, I'd say that the AAP (American Academy of Pediatrics) would most likely have it. 90657 has 1 component - meaning, it only vaccinates against one disease. Ignore the # of valents listed in the code descriptions, and just count the diseases (like those listed under 90669 & 90670). The ones you have to watch out for are MMR (3 components), MMRV (4 components), DTaP (3 components), and 90698 (5 components - DTap, Hib, & polio)...Make sense?

  7. Default
    Perfect sense. THANK YOU SO MUCH!!!

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