Primary Care Coding Alert

Question: When I report a vaccine injection administration plus administration of Rotavirus or FluMist, I get adenial for the second administration due to an error of incorrect administration code. I'm using 90465 and 90467. What codes should I be using?

Indiana Subscriber

Answer: You should use initial administration code 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) for the injectable and subsequent administration code +90468 (Immunization administration younger than age 8 years [includes intranasal or oral routes of administration] when the physician counsels the patient/family; each additional administration [single or combination vaccine/toxoid], per day [List separately in addition to code for primary procedure]) for the oral or inhalant. This combination represents initial administration of an injectable and subsequent administration of an inhaled product such as FluMist, V04.81 (Need for prophylactic vaccination and inoculation against certain diseases; other viral diseases; influenza) or oral product such as Rotavirus, V04.89 (... other viral diseases).

The insurer is correct to deny one of the initial administration codes (90465 or 90467, ... first administration [single or combination vaccine/toxoid], per day). Using two initial administration codes at the same encounter is incorrect coding. After the initial code, you must use a subsequent code, regardless of vaccine method, physician counseling, and patient age. You can add +90468 onto 90465 or 90467.