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Pediatric Coding Alert

New Admin Codes Mirror Old Codes' Delivery Methods, Add-on Rules

Published on Sat Jan 22, 2005

Insider tip: You can choose between 90465-90468 the same way you choose between 90471-90474

Even though you have to learn four new vaccine administration codes this year, CPT makes your task easier by having 90465-90468 echo 90471-90474's differences.
 
To decide which new immunization administration code to use, code based on these guidelines:

Pinpoint the Administration Route

You should choose the primary code based on the type of administration. "You can either inject a vaccine or administer it nasally," says Victoria S. Jackson, CEO of Southern Orange County Pediatric Association in California.
 
The new codes - CPT 90465 and 90467 - mirror the old codes - 90471 and 90473 - in the delivery route that they describe. For an initial vaccine administration of an injection, use either:
 

  • new code 90465 - Immunization administration  under 8 years of age (includes percutaneous, intradermal, subcutaneous, or intramuscular injections) when the physician counsels the patient/family; first injection (single or combination vaccine/toxoid), per day
     
  • or old code 90471 - Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid).

     When staff initially administer a nasal vaccine, report:
     

  • new code 90467 - Immunization administration under age 8 years (includes intranasal or oral routes of administration) when the physician counsels the patient/family; first administration (single or combination vaccine/toxoid), per day
     
  • or old code 90473 - Immunization administration by intranasal or oral route; one vaccine.

    Report the Right Add-on Service

    When the patient receives an additional vaccine, CPT breaks the new add-on administration vaccine codes into similar groupings as the old codes.
     
    Jackson says to report additional vaccine administrations as follows. If staff inject more than one intramuscular or subcutaneous vaccine, assign either:

  • new code +90466 - ... each additional injection (single or combination vaccine/toxoid), per day (list separately in addition to code for primary procedure) (this requires the patient to be under age 8 with physician counseling)
     
  • or old code +90472 - ... each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure).

    If the patient receives the nasal vaccine as the additional vaccine, use either:

  • new code +90468 - ... each additional administration (single or combination vaccine/toxoid), per day (list separately in addition to code for primary procedure) (this requires the patient to be under age 8 with physician counseling)
     
  • or old code +90474 - ... each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure).

    Watch out: After coding the initial vaccine administration, always use add-on codes. Never report two initial vaccine administration codes even if the encounter involves different delivery routes. For instance, a claim should never contain:

    90467 and 90465.
    90471 and 90473.
     
    Appropriate combinations Jackson indicates include:

    90466 in addition to 90465 or 90467.
    90468 with 90467 or 90465.
    90472 in addition to 90471 or 90473.
    90474 with 90471 or 90473. 
     
    Warning: A claim should never contain only add-on vaccine administration codes:

    90466 and 90468
    or 90472 and 90474.

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