Pediatric Coding Alert

Question: A child came to our office for the H1N1 vaccine; she received the initial vaccination during her first visit and the booster during her second visit. How should we bill each visit?

Wisconsin Subscriber

Answer: Although you're administering two doses of the same vaccine, you'll still code the service just once from both visits. Report 90470 (H1N1 immunization administration [intramuscular, intranasal], including counseling when performed) for the administration and  90663 (Influenza virus vaccine, pandemic formulation, H1N1) for the product.

Correct charge: The vaccine product is supplied without a charge, so you won't bill patients for it. When filing your claim, bill for the administration and enter a charge of $0.00 for 90663. Although Medicare does not pay for 90470, CMS set a national value of $22.37 to help other payers that accept the code.