Oncology & Hematology Coding Alert

Question: I coded 90649, 99402 and 90471 for a patient who received the HPV vaccine and counseling in the same session. Unfortunately, my report was denied because the patient was seventeen years old. However, I can't find any age limited codes that involve HPV. What should I do?

New York Subscriber

Answer: The codes you want to use are your original 90649 (Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent [4vHPV], 3 dose schedule, for intramuscular use) in addition to the code 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered).

The latter code accounts for both the immunization and the counseling. Use this code to report the provider administered a single live attenuated vaccine through a parenteral, oral, intranasal, intramuscular, or intravenous to a patient up to 18 years of age. This code also includes the preparation of the patient as well as the provider counseling the patient, providing instructions and precautions before immunization.

Because your code includes these factors, you should not report the counseling code 99402 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 30 minutes) since the 90460 already reports counseling with the administration service.

For situations like these, you need to pay extra attention to the documentation. Be sure to double check the documentation supports the patient was counseled before the vaccination counseling to minimize the chance of denial.