Pediatric Coding Alert

Question: Our physician circled codes for administering a vaccine (90715) and its administration (90471) on the claim form. His only diagnosis is V06.1 (Need for prophylactic vaccination and inoculation against combinations of diseases; diphtheria-tetanus-pertussis combined [DTP] [DTaP]). Are these the right codes? I think he's wrong but he insists he is correct.

New Mexico Subscriber

Answer: The correct administration code depends on the age of the patient and whether the physician performed counseling during the encounter. If he only administered the vaccines -- with no counseling --- or the patient was older than 18 years of age, report 90715 (Tetanus, diphtheria toxoids and acellular pertussis vaccine [Tdap], when administered to individuals 7 years or older, for intramuscular use) and 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]).

If he did perform counseling and the patient was 18 years of age or younger, report 90715 with 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). You would also include 90461 (...each additional vaccine or toxoid component administered [List separately in addition to code for primary procedure]) twice, because Tdap is a three-component vaccine; code 90460 covers the first component, and the two units of 90461 cover the other two components.

Remember: The nurse practitioner, physician assistant, or physician can complete the counseling represented by 90460 and 90461. A registered nurse, licensed practical nurse, medical assistant, or other office staff does not qualify as a "qualified health care professional" who can offer counseling as a billable service under these codes. V06.1 is the correct diagnosis code for this claim.