Pediatric Coding Alert

Question: An established patient came into our ob-gyn office with her mother and they wanted to talk about whether the girl (who is 17) should have the HPV vaccine. Our doctor counseled the patient for 20 minutes on the benefits and she decided at that time to have the vaccine. How do I report the counseling and vaccine on the same day?

Georgia Subscriber

Answer: You should report 99402 (Preventive medicine counseling and/or risk factor reduction intervention[s] provided to an individual [separate procedure]; approximately 30 minutes) for the human papillomavirus (HPV) vaccine counseling. Also report 90649 (Human Papilloma virus [HPV] vaccine, types 6, 11, 16, 18 [quadrivalent], 3 dose schedule, for intramuscular use) for the vaccine and 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) for the vaccine administration.

Since the counseling and the administration of the vaccine take place during the same visit, your payer may want you to append the modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99402.

You should link V65.45 (Counseling on other sexually transmitted diseases) to 99402 and either V04.89 (Need for prophylactic vaccination and inoculation against other viral diseases) or V05.8 (Need for prophylactic vaccination and inoculation against other specified disease) to 90649 and 90471.

ICD-10 codes: When ICD-10 goes into effect on October 1, you’ll replace V65.45 with Z71.89 (Other specified counseling) and V04.89 or V05.8 with Z23 (Encounter for immunization).