Primary Care Coding Alert

Question: If a family physician (FP) provides the counseling and steps out of the room during the administration, may she use 90465?

Massachusetts Subscriber

Answer: Many offices are wondering the same thing - what exactly does the FP have to do to report the new pediatric-specific vaccine administration codes (90465-90468, Immunization administration under 8 years of age ... when the physician counsels the patient/family; ...).
 
The new codes do not require that the physician actually administer the vaccine. To report 90465-90468, the physician must perform face-to-face vaccine counseling during that patient encounter. The nurse may administer the vaccine.
 
Bad news: Medicare assigned the same work relative value units (0.17) to the new PSIA codes as the original vaccine administration codes (90471-90474) contain. So your FP won't receive any more money for using the counseling codes. The American Academy of Pediatrics (AAP) is appealing the decision.