Pediatric Coding Alert

Question: Our billing department has been reporting 90474 when the pediatrician administers a FluMist or rotavirus immunization for children under the age of 18 when other vaccines are billed on the same day. I have been given information that we should be billing code 90460 instead if the vaccines are given by our doctors and they are counseling on the effects of the vaccine. Can you please let me know which way is correct.

Georgia Subscriber

Answer: Your new information is accurate. If the physician or other qualified health care professional is providing counseling for a child less than 19 years of age, then the "new" pediatric component based codes should be used, regardless of who actually administers the vaccine.

In the case of FluMist, a one component vaccine, 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) would be the correct code to use. If it was a nurse-only "flu clinic" encounter, 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]) would be the correct code.

Code +90474 (...each additional vaccine [single or combination vaccine/toxoid]) would only be accurate if there was another vaccine given as a nurse-only visit at the same encounter.