Pediatric Coding Alert

You'll soon capture counseling per disease with universal multivaccine ICD-9 code.

For combination vaccines that may involve counseling on as many as five different diseases, getting paid as though you counseled on one never seemed fair, but CPT 2011 lets you capture that extra counseling work.

"Multiple component vaccines (Pentacel, Kinrix, MMRV) have had an economic disincentive related to the loss of immunization administration codes with these vaccines," says Richard Tuck, MD, FAAP, pediatrician at PrimeCare of Southeastern Ohio in Zanesville. Combination vaccines involve counseling on each product. Since the current CPT vaccine administration codes (90465-90467) are coded per vaccine, the codes capture payment for only one counseling administration code.

CPT 2011 will delete codes 90465-90468 (Immunization administration younger than 8 years of age ... when the physician counsels the patient/family ... per day). The 90471-90474 (Immunization administration ...) codes will remain.

Great news: In 2011, you will report the immunization administration with counseling codes per component. Here's how:

Step 1: Use 90460 as Vaccine Administration W/ Counseling Base Code

No more looking at administration route when choosing which immunization administration with counseling code. For vaccine administration except for H1N1, you'll assign one code for each vaccine's initial component:

90460 -- Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component.

Definition: A component refers to the antigen in a vaccine that prevents disease caused by one organism.

CPT streamlines your coding of the vaccine counseling codes by giving you one universal base code. The code includes "any route of administration." You no longer have to choose a different code based on whether the code is intramuscular/subcutaneous or oral/intranasal.

Step 2: Report Second Vaccine Component With +90461

Pediatric coders can breathe a sigh of relief as the complexities over deciding which 90465-90468 code to use as the base code will soon end. CPT 2011 gives you only one vaccine administration with counseling base code (90460). For each additional vaccine component, you report the same add on code:

+90461 -- Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (List separately in addition to code for primary procedure).

If the physician, nonphysician practitioner (NP), physician assistant (PA), or other healthcare qualified professional provides vaccine counseling to a patient less than 19 years old for a second disease/component, you'll assign +90461 for the second vaccine component. You will always report +90461 in addition to 90460.

Step 3: Use Units to Report 3+ Administrations

You'll keep using the same add-on code, +90461, for each additional vaccine component. Bill the add-on code, plus the number of units that represents the number of components.

Example: A pediatrician counsels a mother on vaccine risks and benefits prior to giving the patient Pediarix, which has five components: DTaP-HepB-IPV. The diphtheria, tetanus toxoids, acellular pertussis each count as one component, plus Hepatitis B and inactivated polio virus each count as one. For the vaccine administration with counseling on the components included in Pediarix (90723) (if administered in conjunction with a preventive medicine service [99381-99397]: V20.2,Routine infant or child health check; when administered at an alternative encounter:V06.8, Need for prophylactic vaccination and inoculation against other combinations of diseases; Other combinations), using CPT 2011 codes, you should report:

90460

+90461 x 4.

For multiple component vaccines that lack a single specific ICD-9 code, the American Academy of Pediatrics recommends using the general multitoxoid ICD-9 code: V06.8. The ICD-9 guidelines requiring assigning a second diagnosis from categories V03-V05 to identify any vaccinations not included in a combination code is being revised.