Pediatric Coding Alert

Question: Can you explain when we use the different rotavirus vaccine codes?

Maine Subscriber

Answer: You administer both vaccines to help prevent gastroenteritis in infants and children, so base your coding on whichever rotavirus vaccine the provider uses. For RotaTeq, submit 90680 (Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use). For Rotarix, report 90681 (Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use).

Administration: Don't forget to include a code for the actual vaccine administration. If the provider administers only the rotavirus vaccine, report 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]). Include +90474 (... each additional vaccine [single or combination vaccine/toxoid] [List separately in addition to code for primary procedure]) with the other applicable vaccine code if the provider administers multiple vaccines during the same visit. You can report only one "initial" vaccine administration during a visit, so bill the injectable product first (as your initial vaccine), then follow with any oral administrations.

Diagnosis: Link diagnosis V04.89 (Need for prophylactic vaccination and inoculation against certain diseases; other viral diseases) to code 90680 or 90681.