Pediatric Coding Alert

Question: We did not have a children’s dose of the flu vaccine in stock, so our provider administered a half dose of 90688 to one of our pediatric patients. As we cannot put half or .5 in the units of service for the code, how should we bill this? Should we bill out under 90687? Or should we use a 52 or 53 modifier?

Codify Subscriber

Answer: In this instance, you would not use 90687 (Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.25 mL dosage, for intramuscular use) as the vaccine vial your pediatrician opened contained the 0.5 mL dose. So, 90688 (Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use) would be correct as the vial is considered used once opened regardless of whether part of the dosage was lost due to spillage or wastage during the administration.

Additionally, no modifier is necessary under these circumstances, especially not 52 (Reduced services) or 53 (Discontinued services), as neither reflects the issue in this particular encounter. Modifier 52, for example, would not be used as the service was not actually reduced — the provider went ahead and performed the needed service on the patient by administering the dose required. And modifier 53 would definitely not be appropriate in these circumstances, as the provider completed the procedure and did not terminate it for the well-being of the patient.