Pediatric Coding Alert

You no longer have to think of clinical staff work preparing vaccines as give-away services.

Because many Medicaid carriers and private payers set their payment rates based on the Medicare physician fee schedule values, a boost to the vaccine administration codes' practice expense relative values should trickle down to your claims'

payments, explained Amy Bassano, MA, director of CMS hospital and ambulatory policy group in "Medicare Physician Payment Schedule 2009 Changes and Beyond" at the CPT and RBRVS 2009 Annual Symposium in Chicago.

CMS had originally said that it would not pay for clinical staff time spent regarding vaccine administration quality assurance, Bassano noted. "But when we looked at other similar services, we realized the relative value units (RVUs) included that

time." So CMS added that into immunization administration codes 90465 (Immunization administration younger than 8 years of age [includes percutaneous, intradermal, subcutaneous, or intramuscular injections] when the physician counsels the

patient/family; first injection [single or combination vaccine/toxoid], per day), 90467 (Immunization administration younger than age 8 years [includes intranasal or oral routes of administration] when the physician counsels the patient/family; first

injection [single or combination vaccine/toxoid], per day), 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid), and 90473

(Immunization by intranasal or oral route; one vaccine [single or combination vaccine/toxoid]).

Example: Codes 90465 and 90471 get a 0.02 added practice expense boost to bring each of their total RVUs to 0.58 in 2009. The added 72 cents (0.02 x 2009 conversion factor of 36.0666) means that if your practice administers 25 initial

injectable vaccines per week, you could see almost an extra $940 (25 administrations x 52 weeks x $0.72 = $936) for the year.