Oncology & Hematology Coding Alert

Question: Our physician administered the human papillomavirus (HPV) vaccine and did counseling for an established patient. The counseling and vaccine administration were done in the same encounter. The clinical records indicate that our physician spent 25 minutes discussing risks, benefits, and potential side effects of the vaccine. How can we code for the counseling and vaccine administration? Can we separately report these two services?

Connecticut Subscriber

Answer: You can report for both counseling and vaccination. From the description shared, the counseling prompted the patient to take the vaccination. On the claim, you should report codes for counseling, vaccine, and immunization administration. Submit the following codes for adults over the age of 18:

• 99402 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 30 minutes) for the counseling;
• 90649 (Human Papillomavirus [HPV] vaccine, types 6, 11, 16, 18 quadrivalent [4vHPV], 3 dose schedule, for intramuscular use) for the vaccine supply; and
• 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) for the vaccine administration.

Important patient age related note: For patients 18 years old or less, the vaccine administration CPT^® code 90460 would replace 90471 and 99402 above

90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified healthcare professional; first only component of each vaccine or toxoid administered).

Always make certain the documentation clearly supports both services. Check with your local payers to make certain they will recognize the code supported by the documentation in the chart.

Append modifier: Since the vaccine administration and the counseling are reported for the same date, you may need to make this clear for your payers. If these codes are reported with an evaluation and management service, the E&M would require a modifier 25 when documentation supports.  The documentation should support the patient received counseling and subsequent to the counseling, the patient decided to be vaccinated.

Rule out scheduled vaccines: If the patient had reported for a scheduled HPV vaccine administration, then the counseling is not coded separately.

Note this as an exception to the case you have described in the query.