Pediatric Coding Alert

Question:

Virginia Subscriber

Both 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component) and +90461 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component [List separately in addition to code for primary procedure]) state, "with counseling by physician or other qualified health care professional."

The ultimate determination on which practitioners can perform counseling is determined on an individual state-by-state basis according to the state-defined scope of practice.

In its document "FAQ Fact Sheet for the 2011 Pediatric Immunization Administration Codes," the American Academy of Pediatrics notes, "To report CPT^® codes 90460-90461, the physician or the qualified health care professional who is reporting the service must perform face-to-face counseling (and so document that the counseling was personally performed). To determine if someone other than a physician meets the criteria of a qualified health care professional, each practice should refer to its particular state scope of practice laws." (http://practice.aap.org/content.aspx?aid=2980).

Bottom line: Check your state and insurer guidelines and keep a copy of those requirements in writing so you can quickly select the appropriate vaccination code based on which practitioner performed the service.