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Primary Care Coding Alert

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1 Example Reveals Your Vaccine Administration Coding Aptitude

Published on Thu Jan 27, 2005

 Find out if staff are up to par on 90465-90474 reporting

See if you can apply the main concepts discussed in the article "Reserve New Vaccine Admin Codes for Same-Day Counseling, Immunization" to the following real-world scenario.
 
Key points: You should only use new vaccine administration codes 90465-90468 when the encounter meets these two criteria:
 

  • the child is under 8 years of age
     
  • the family physician or nonphysician practitioner performs prevaccine counseling on the same day as staff administer the immunizations.

    Example: A 4-year-old established patient returns after a sick visit for an immunization-only visit. A nurse counsels the parent regarding the vaccine products, reaction and concerns. The patient receives a varicella vaccine shot and a FluMist intranasal immunization. No significant nurse E/M occurs. How should you report the claim?
     
    Answer: For the immunization and vaccine administration, you should report:
     

  • the varicella vaccine as 90716 (Varicella virus vaccine, live, for subcutaneous use)
     
  • the initial vaccine injection as 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid])
     
  • the influenza vaccine with 90660 (Influenza virus vaccine, live, for intranasal use)
     
  • the additional intranasal vaccine admin as +90474 (Immunization administration by intranasal or oral route; each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]).
     
    Reason: Because the family physician doesn't do the counseling, you have to use the noncounseling vaccine administration codes, 90471-90474, says Victoria S. Jackson, president of OMNI Management, a consulting firm in California.
     
    In this case, the nurse administers one immunization using each vaccine delivery route. Therefore, you should report the initial noncounseling injection with 90471 and the additional noncounseling intranasal vaccine as 90474.

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