Primary Care Coding Alert

Question: Can you settle a dispute our office is having? Do we need to use modifier 51 when we report a vaccine administration and vaccine?

Arizona Subscriber

Answer: Although immunization administration and vaccine product billing involves two CPT codes, these cases do not require modifier 51 (Multiple procedures). Reserve the modifier for multiple procedures "other than E/M services, physical medicine and rehabilitation services, or provision of supplies (such as vaccines)," according to modifier 51's revised description in CPT 2008. CPT 2008 also confirms this instruction in language added to the "Vaccines, Toxoids" subsection introductory notes. "Modifier 51 should not be reported for the vaccines, toxoids when performed with these administration procedures" (90465-90474), according to the added directive in CPT 2008.

Get this: The added language prompted the AMA to mark each vaccine and toxoid code as revised. No, CPT did not change each code's descriptor, as the arrow preceding each code suggests. But the introductory note stipulating that modifier 51 is not necessary warranted the revised designation.

How it works: A nurse gives a final third "make-up" shot for hepatitis A in a 10-year-old child. You should code:

- 90634 (Hepatitis A vaccine, pediatric/adolescent dosage -- 3-dose schedule, for intramuscular use) for the product

- 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]) for the intramuscular immunization administration for a patient 8 years of age and older

- V05.3 (Need for other prophylactic vaccination and inoculation against single diseases; viral hepatitis) to represent the specific vaccine. This encounter does not involve a preventive medicine service, making it better to use the specific vaccine V code rather than V20.2 (Routine infant or child health check).