EM Coding Alert

Question: How should I bill the administration of the second and third shot of Gardasil? Can I also use code 99211?

Louisiana Subscriber

Answer: Gardasil helps to prevent cervical cancer, precancerous genital lesions, and genital warts caused by human papilloma virus (HPV) types 6, 11, 16 and 18. The product is approved for use in females 9-26 years of age, so you should report the administration code 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]), if this is the only injection service the physician provides that day.

For the product Gardasil, you should report 90649 (Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent [4vHPV], 3 dose schedule, for intramuscular use).

You would report Z23 (Encounter for immunization) for the vaccination against HPV.

However, you should not report 99211 (Office or other outpatient visitfor the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services) just for the second and third Gardasil injections.

Remember, you should never use 99211 as a catchall code. To appropriately bill a 99211, there has to be medical necessity, meaning the physician did a workup of some sort. The medical documentation must show that the service meets the minimum requirements for an E/M visit. Just administering an injection does not meet those requirements.