Pediatric Coding Alert

Question: We have a 7-week-old patient who presented for a DTaP-IPV/ Hib vaccine. The pediatrician counseled the parent. There are several components in that one vaccine, so do I report 90698 multiple times?

Arizona Subscriber

Answer: The code for that vaccine is 90698 (Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP-IPV/Hib), for intramuscular use). However, accurate coding depends on correct usage of administration codes and units.

The pediatrician counseled the parent, so you’ll need to report 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered). There are five components identified in 90698, as the descriptor indicates. This means you want to report each unit, but instead of reporting the vaccine code five times, you should report 90460 once and then report the add-on code +90461 (… each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure)) four times to account for each unit.