Pediatric Coding Alert

Question: After a pediatrician provides vaccine counseling for an infant, a nurse administers Rotateq in addition to other injectable vaccinations. Should I report the Rotateq administration with 90467 or 90468?


New Jersey Subscriber

Answer: When coding immunization administration, you should only report one initial administration code (with physician counseling and patient younger than age 8: 90465 or 90467; without physician counseling or patient age 8 or older: 90471 or 90473). This rule applies even if the administration involves different administration routes, such as injectable and oral.

Because Rotateq is an oral vaccine, choose between 90467 or 90468 (or 90473 and 90474) based on whether the encounter involves other injectable vaccines. Here's how to assign the correct administration code for an encounter involving physician counseling and a patient younger than age 8:

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

Injectable vaccine and Rotateq: When Rotateq is administered in addition to another injectable vaccine, report the Rotateq oral administration with +90468 (... each additional administration [single or combination vaccine/toxoid], per day [list separately in addition to code for primary procedure]). Report the administration of the injectable with 90465. This would be the appropriate vaccine administration CPT code combination for the scenario that you describe.

Do not code two initial administrations, such as 90465 for an injectable vaccine and 90467 for the Rotateq administration. Code 90467 is inclusive to/cannot be billed with 90465 (Immunization administration younger than age 8 years [includes percutaneous, intradermal, subcutaneous, or intramuscular injections] when the physician counsels the patient/family; first injection [single or combination vaccine/toxoid], per day). Submitting this combination will result in payment delays due to coding edits in 90465 and 90467.