Pediatric Coding Alert

Question: What immunization administration (IA) code should I use for FluMist? Because this is an inhaled product, CPT 90471 -90472 seem inappropriate. Do these codes contain no CMS values?


Ohio Subscriber

Answer: You are correct that you should report IA of an injected product with 90471-90472 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; ...). When you administer an intranasal (FluMist) or oral immunization, you should instead assign 90473-90474 (Immunization administration intranasal or oral route ...).

If a pediatrician or nonphysician practitioner provides vaccine counseling and the patient is under 8 years old, you should instead assign 90467-90468 (Immunization administration under 8 years of age ... when the physician counsels the patient/family ...) for intranasal or oral administration.

Great news: The Proposed Physician Fee Schedule (PPFS) for 2006 assigns relative value units (RVUs) to the four intranasal/oral IA codes (90467, 90468, 90473 and 90474). These codes now have an R status (Restricted coverage) and 0 RVUs. In 2006, the codes will still carry an "R," which means "Special coverage instructions apply." But CMS has assigned RVUs to the codes, so they will no longer be carrier-priced.

CMS assigned proposed values for the intranasal/oral IA codes that echo the corresponding injection IA code's values. The PPFS lists the same new values for 90467 (Intranasal/oral IA with physician counseling; first administration) and 90473 (Intranasal/oral IA; one vaccine) that 90465 (Injection IA with physician counseling; first injection) and 90471 (Injection IA; one vaccine) now contain. The RVUs include:

• 0.17 for physician work

• 0.31 for nonfacility practice expense

• 0.49 for nonfacility total.

CMS also assigned the same values for add-on codes +90468 (Intranasal/oral IA with physician counseling; each additional administration) and +90474 (Intranasal/oral IA; each additional vaccine) as for add-on codes +90472 (Injection IA; each additional vaccine) and +90466 (Injection IA with physician counseling; each additional injection). The PPFS lists the following RVUs:

• 0.15 for physician work

• 0.13 for nonfacility practice expense

• 0.29 for nonfacility total.

Another possibility: The American Academy of Pediatrics would also like the final rule to list values for 92551 (Screening test, pure tone, air only) and 99173 (Screening test of visual acuity, quantitative, bilateral). The 2006 PPFS did not publish RVUs for the hearing and vision screening codes.

--Answers to You Be the Coder and Reader Questions provided by Richard A. Molteni, MD, FAAP, a neonatologist and medical director at Children's Hospital and Regional Medical Center in Seattle; Dennis Padget, president of Padget and Associates in Simpsonville, Ky.; Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio; and Gretchen Segado, MS, CPC, director of reimbursement compliance at New York University School of Medicine.