Gastroenterology Coding Alert

Question: How should I code hepatitis A and hepatitis B injections? We have the medication in the office.

Connecticut Subscriber Answer: You should bill 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]) for the administration. Don't forget to report:

- 90636 (Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use) for A and B, and

- 90633 (Hepatitis A vaccine, pediatric/adolescent dosage, 2-dose schedule, for intramuscular use) or 90634 (Hepatitis A vaccine, pediatric/adolescent dosage, 3-dose schedule, for intramuscular use) for A only. Watch out: If your nurse provides the administration (90471), you should be wary of reporting an E/M visit. The National Correct Coding Initiative bundles the codes for immunization administration for vaccines and toxoids with 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician), and you can't break the bundles.