Primary Care Coding Alert

Question: Regarding the counseling code for vaccines administered to patients less than eight years of age, can you bill for 90471 in addition to 90465? Insurers pay the codes at the same rate.

California Subscriber

Answer: You can use only one first administration code. Report either:

- 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

- 90471 -- Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid).

Do not report 90465 and 90471 together. Use code 90465 when the nurse administers a shot to a child less than eight years of age and the physician provides counseling before the administration. If these two criteria are not met, you would instead use 90471.

For a second injection administration, use +90466 (... each additional injection [single or combination vaccine/toxoid], per day [list separately in addition to code for primary procedure]) or +90472 (... each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]).

Payment: Although the 2008 Medicare Physician Fee Schedule assigns the same amount of relative value units (0.56) to 90465 and 90471, some third-party insurers are paying more 90465. Physicians are also petitioning Medicare to make this adjustment in the future. For accuracy and correct payment down the road, you should get in the habit of distinguishing immunization administration documented as 90465-90468 from 90471-90474.

-- Answers to You Be the Coder and Reader Questions contributed or reviewed by F Tessa Bartels, CPC, CPC-E/M, reimbursement manager for pediatric surgery/craniofacial remodeling at Medical College of Wisconsin in Milwaukee; Kent J. Moore, manager of Health Care Financing and Delivery Systems for the American Academy of Family Physicians in Leawood, Kan.; Richard H. Tuck, MD, FAAP, at PrimeCare of Southeastern Ohio in Zanesville; and Melanie Witt, RN, CPC-OBGYN, MA, a coding consultant in Guadalupita, N.M.