Pediatric Coding Alert

Hint: You won’t always need V20.2.

Your pediatric practice probably administers vaccines many times a day, but that doesn’t mean your coding is impeccable for these services. Check out the following three frequently asked vaccine coding questions so you can ensure that you’re reporting immunizations correctly.

Question 1: Can We Report 90460-90461 If the Nurse Administers the Vaccine But the Doctor Doesn’t Counsel the Patient?

Answer: You absolutely should not report these codes if no counseling was provided at the encounter when the vaccine is administered. 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 or only component of each vaccine or/toxoid administered) 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 or/toxoid component administered [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, but typically includes the physician, nurse practitioner, and physician’s assistant. 

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. 

Question 2: Is V20.2 Required to Report Vaccines?

When you administer a vaccine, you may be tempted to automatically circle V20.2 (Routine infant or child health check) on the superbill—but this isn’t always correct coding. Although V20.2 is certainly the most common diagnosis code for this purpose, and is usually payable, it is not your only option. 

On its Vaccine Coding Table, the American Academy of Pediatrics (AAP) notes that such requests are possible during well-child checks (http://practice.aap.org/content.aspx?aid=2334), stating, “ICD-9-CM guidelines indicate that immunizations administered as part of a routine well-baby or well-child check should be reported with code V20.2. The [specific immunization V] codes listed in this table can be reported in addition to V20.2 if specific payers request them. Immunizations administered in encounters other than those for a routine well-baby or well-child check should be reported only with the [V] codes listed in this table.” 

If you have an electronic health record, most of these EHR software programs link each vaccine given to the appropriate diagnostic code for that vaccine. Very few EHRs will allow or want you linking to the V20.2 code. Under ICD-10, there will be only one Z code (Z23) to replace the V codes for vaccines, so you’ll use Z23 (Encounter for immunization) on all of your vaccines.

Therefore, if your payer specifically requests individual ICD-9 diagnoses linked to each vaccine administered during a well-child visit, refer to the AAP’s table. For instance, a live MMR vaccine (90707) would be billed with V06.4 (Need for prophylactic vaccination with Measles-mumps-rubella [MMR] vaccine). 

Question 3: Can We Report A Syringe Code With Vaccine Administration? 

Answer: Unfortunately, the answer is “no” to your question when you’re dealing with Medicaid, Medicare, and most private insurers follow this lead. You should not code a syringe (A4206, Syringe with needle, sterile 1 cc, or less, each; A4208, Syringe with needle, sterile 3 cc, each) in addition to vaccine administration. 

Why: The practice expense (PE) for vaccine administration codes includes the related equipment, including the syringe and post-vaccine bandages.