Primary Care Coding Alert

Question: A 15-year-old has a preventive medicine visit with the FP. The physician counsels the patient on vaccine risks before the nurse gives Tdap. Can I use 90465 for the counseling with vaccine administration?

Georgia Subscriber

Answer: You should use 90471 (Immunization administration [includes percutaneous, intradermal,subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]), not 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).

The vaccine administration with counseling code 90465 requires that the patient be less than 8 years of age. When the patient is 8 years of age or older, you have to use the vaccine administration without counseling codes (90471-90474), rather than the vaccine administration with counseling codes (90465-90468), regardless of whether the physician counsels the patient or not.