Ob-Gyn Coding Alert

Question: My ob-gyn sometimes administers the pneumococcal vaccine to his patients, and I heard CPT 2010 will now include a code for the PCV-13 vaccine. Is that true? Also, can we bill the vaccine with administration and E/M service codes?

Florida Subscriber

Answer: True. If your ob-gyn administers a pneumococcal vaccine, you have two codes from which to choose. They are:

• 90669 -- Pneumococcal conjugate vaccine, 7 valent, for intramuscular use (revised); and

• 90670 -- Pneumococcal conjugate vaccine, 13 valent, for intramuscular use (new).

Code 90669 (commonly referred to as the PCV-7 vaccine) now replaces the term "polyvalent" with "7 valent." The FDA will soon approve the vaccine represented by code 90670 (referred to as the PCV-13 vaccine). Both vaccines will be on the market simultaneously, and you will have to differentiate them via these two codes. Action: Make certain your ob-gyn knows his documentation must clearly state which pneumococcal vaccine he administered. If your physician also provides a separate significant E/M service at the time of administration, you can bill a problem E/M service in addition to the administration code (90471, Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]).

For example, the patient presents for follow-up care after the ob-gyn placed a Pessary for uterine prolapse. At that visit, the physician asks the patient about current immunizations and notes that she would be eligible for the pneumonia vaccine. In that case, he may have documented a level three E/M service and the billing would go in as 99213-25 (Office or other outpatient visit ...; Significant, separately identifiable evaluation and management service on the same day of a procedure or other service), 90471, and 90669 or 90670. CPT guidelines state that you should not add a modifier 51 (Multiple procedures) to 90471 when reported with other services.