Internal Medicine Coding Alert

HPV Vaccine Requires More Than 1 Code

Question: We have started administering the new human papilloma virus (HPV) vaccine. Which code should we report for this service?


Tennessee Subscriber

Answer: You should report 90649 (Human papilloma virus [HPV] vaccine, types 6, 11, 16, 18 [quadrivalent], three-dose schedule, for intramuscular use) for the vaccine and 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]) for the administration.

This vaccine recently received FDA approval to help protect against certain types of HPV, which often precede cervical cancer. Although your CPT manual includes the symbol for "FDA approval pending" with 90649, the AMA has removed the symbol on its Web site (www.ama-assn.org/ama/pub/category/10902.html).

Your diagnosis should be V04.89 (Need for prophylactic vaccination and inoculation against certain viral diseases; other viral diseases).

Also, if your internist provides a significant and separate E/M service during the same visit that she administers the vaccine, you may also bill an E/M code appended with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to inform the payer that the E/M service was separate.