Pediatric Coding Alert

Question: When we give immune globulin (90281) for traveling out of the country, is the immunization covered?


Illinois Subscriber


Answer: Watch out: Code 90281 (Immune globulin [Ig], human, for intramuscular use) is an immune globulin, not an immunization. When you code the product, make sure to report the associated administration using a prophylactic injection code (90772, Therapeutic, prophylactic or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular), not an immunization administration code (90465-90466 or 90471-90472).

Coverage will ultimately lie with the individual insurer and plan. But don't rule out payment for 90281 with ICD-9 code V07.2 (Prophylactic immunotherapy). At least one insurer -- Aetna -- lists the code as a covered ICD-9 code for 90281. To view Clinical Policy Bulletin Number 0206, visit www.aetna.com/cpb/medical/data/200_299/0206.html.

Don't overlook: Make sure you also report any service rendered, such as (99212-99215, Office visit for the E/M of an established patient), with V70.3 (General medical examination; other medical examination for administrative purposes). Payers may require modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) on the associated E/M service code.