Pediatric Coding Alert

Question: The February Pediatric Coding Alert article "This 3-Point Checklist Helps You Use the Right Vaccine Admin Code Set" states that we  should use the new vaccine administration codes when a patient is under 8 years of age and the pediatrician performs counseling. Our pediatricians always perform counseling. May we assume that the visit qualifies for 90465-90468 whenever a patient under age 8 receives a vaccination even if the physician doesn't mention the counseling?


New Jersey Subscriber

Answer: No. The pediatrician who gives the vaccine counseling must document in the patient's chart that he gave the counseling. The physician should also specify which vaccine he discussed.

Why: You may use both noncounseling and counseling vaccine administration codes during the same encounter. For example, a patient may receive a vaccine that is new and a "repeat" vaccine (such as, the third hepatitis B vaccine in the series). The pediatrician may provide vaccine counseling on the new vaccine but not on the repeat vaccine.

In this case, you should use a counseling code 90465-90468 (Immunization administration under 8 years of age when the physician counsels the patient/family ...) and a noncounseling code 90471-90474 (Immunization administration ...). Report 90465 for the first vaccine administration with pediatrician counseling and 90472 for the second shot administration for which the physician doesn't provide counseling.

 - Answers to You Be the Coder and Reader Questions provided by Richard Lander, MD, FAAP, a pediatrician at Essex-Morris Pediatric Group in Livingston, N.J.; Richard Tuck, MD, FAAP, a member of the American Academy of Pediatrics national committee on coding and nomenclature; Denise Salton, financial counselor at Virginia Beach Pediatrics in Norfolk; and Sherry Wilkerson, RHIT, CCS, CCS-P, coding and compliance manager at CHAN Healthcare Auditors in St. Louis, Mo.