Pediatric Coding Alert

Although CPT Codes 2005 will complicate vaccine administration coding, this quiz will help you submit flawless 90465-90474 claims.
 
Follow the five actions in "This 3-Point Checklist Helps You Use the Right Vaccine Admin Code Set" and "New Admin Codes Mirror Old Codes' Delivery Methods, Add-on Rules" and see if you score 100 on these three expert-provided scenarios:
 
Example 1: After a pediatrician provides face-to-face vaccine counseling during a preventive medicine service for a 4-year-old established patient, a nurse administers a varicella vaccine injection and gives a dose of the intranasal influenza immunization, FluMist. Code the case.
 
Answer 1: You should report the encounter with:
 

99392 for the preventive medicine service
 

90716 for the varicella vaccine
 

90465 for the initial vaccine injection administration
 

90660 for the influenza vaccine
 

90468 for the additional intranasal vaccine admin.

Why: You should assign the pediatric-specific vaccine administration codes (90465-90468) because the child is under 8 years of age and the pediatrician performs the counseling, says Victoria S. Jackson, CEO of Southern Orange County Pediatric Association with 11 pediatric offices in California. "The pediatrician doesn't have to give the injection to use these codes."
 
The nurse uses the injection method for the primary vaccine administration, and the intranasal delivery route for the additional immunization administration. So, you should report the initial injection code with 90465 and the additional intranasal code as 90468.

Example 2: A 4-year-old established patient returns after a sick visit for an immunization-only visit. A nurse counsels the parent regarding the vaccine products, reaction and concerns. The patient receives a varicella vaccine shot and a FluMist intranasal immunization. No significant nurse E/M occurs. How should you report the claim?
 
Answer 2: For the immunization and vaccine administration, you should report:
 

90716 for the varicella vaccine
 

90471 for the initial vaccine injection
 

90660 for the influenza vaccine
 

90474 for the additional intranasal vaccine admin.
 
Reason: Because the pediatrician doesn't do the counseling, you have to use the non-counseling vaccine administration codes, 90471-90474, Jackson says.
 
In this case, the nurse administers one immunization using each vaccine delivery route. Therefore, you should code an initial non-counseling injection with 90471 and an additional non-counseling intranasal immunization as 90474.
 
Example 3: A pediatrician performs face-to-face vaccine counseling and administers the varicella vaccine and FluMist to a 9-year-old new patient during his annual well check.
 
Answer 3: The claim should read:
 

99383 for the preventive medicine service
 

90716 for the varicella vaccine
 

90471 for the initial injection administration
 

90660 for the influenza vaccine
 

90474 for the additional intranasal vaccine admin.

Why: You have to revert to the old vaccine administration codes because the child doesn't meet 90465-90468's age criteria. "The patient is not under 8 years of age," Jackson says.
 
As you should have done prior to CPT 2005's creation of 90465-90468, you would report 90471 for the initial injection and 90474 for the additional intranasal vaccine administration.