Pediatric Coding Alert

These VFC FAQs help you report the seemingly impossible.

Sure, you know what Vaccine for Children (VFC) does, but getting paid for the work without charging for the supply can prove as tangled as any government program. These 3 FAQ answers will help you unravel the guidelines.

How DoYou Report the Supplied Product?

States track supply used in the VFC program by vaccine code, notes Robin Linker, CPC, CPC-H, CCS-P, CPC-P, MCS-P, CHC, chief executive officer of Robin Linker & Associates Inc. in Aurora, Colo. Youre getting free vaccine and reporting the product.

Crucial: Keep track of each vial in your vaccine log. If youre ever audited, youll have a trail showing to whom you gave each vaccine. The Department of Health can pop in anytime for a visit, Linker warns.

To report the supply without charging for it, programs may require the following three steps, confirms Pam Tienter, CPC, CPC-P, CCS-P, compliance educator with Park Nicollet Health Services in Minneapolis.

1. Code for the vaccine (90476-90749)

2. Append the vaccine code with modifier SL (State supplied vaccine)

3. Enter a zero charge ($0.00).

Then the Medicaid plans know whats being given, Tienter relays.

Warning: Check your individual plans charge requirements. Many VFC programs, including New Hampshire Blue Cross and New Hampshire Medicaid, and Minnesota Medicaid, want the product reported with a zero fee as shown above. Some programs, such as Medi-Cal, instead want the administration allowed charge entered with modifier SL on the product, such as Pentacel (90698-SL, Diphtheria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenza Type B, and poliovirus vaccine, inactivated [DTaP-Hib-IPV] for intramuscular use). Others may not require modifier SL.

What Administration Codes Does VFC Allow?

Dont assume that because youre providing a free product the whole vaccine package is a freebie. You should still get paid for the administration. Each state has a certain allowable for the administration of the vaccine.

Most programs have you charge the allowable by adding an administration code for each vaccine. I currently use the following administration codes: 90465, +90466,90467, and 90471, +90472, 90473, notes Heather Smith CPC, CMC, clinic coding/auditing coordinator with South Haven Community Hospital in Michigan.

To choose the correct administration code, look at:

" whether the encounter involved the pediatrician (or nurse practitioner [NP]/physicians assistant [PA]) counseling a patient who is younger than 8 years of age:90465-90467 (Immunization administration younger than 8 years &when the physician counsels the patient/family ...).If the patient isnt counseled by the provider (at any age) or is over the age of 8, then we use the 90471-90473 (Immunization administration&) administration codes with the vaccines provided, Smith says.

" and the administration route. When giving multiple vaccines, always code the injection (90465, +90466,90471, and +90472) as the initial vaccine given and the oral or intranasal administration (90467, +90468, 90473,or +90474) as the subsequent. The relative value amount is higher for the initial injection versus the initial oral/intranasal vaccine administration.

What Products Will The Program Provide?

The product the state carries will determine which CPT code you will use. For example, HIB has a 3-dose (90647,Hemophilus influenza b vaccine [Hib], PRP-OMP conjugate [3 dose schedule], for intramuscular use) and a 4-dose schedule (90648, Hemophilus influenza b vaccine [Hib],PRP-T conjugate [4 dose schedule], for intramuscular use).

If your state follows the mainly used method of charging the product at $0 and using an administration code, a HIB 3-dose entry could look like this:

Method 2: In contrast, Medi-Cal wants only the product entry: 90647-SL, V20.2 at allowable ($9 for Medi-Cal).

Federal law caps the administration allowable for the VFC program geographically at $17.55 per dose (not per vaccine antigen). Medi-Cal then reimburses the vaccine administration at $9 per dose. Compare your states rate to other states caps at www.cdc.gov/vaccines/programs/vfc/fee-fedreg.htm#table.

Bottom line: Know your state rules to capture payment for your VFC work.