Primary Care Coding Alert

Question: At an 18-month preventive medicine service, the FP noted that the toddler had missed one of her three scheduled DTaP shots. Today, the mother brought the toddler, who has a history of bronchiolitis, in for a flu shot and the catch-up injection. The mother told the nurse that the child was fine and that she had already been counseled on the vaccine and had no concerns. The nurse proceeded to review the vaccine history, present the VIS, and receive the physician's order for the Fluzone and DAPTACEL. She then administers and documents the DTaP shot and a flu vaccine with preservatives. Should I report an E/M service in addition to the immunization administration?

North Carolina Subscriber

Answer: No. In this situation, the nurse provided a service that was only vaccine-related and did not provide a significant or separate E/M service; code the immunization administrations and the product codes.

Because this is not a preventive medicine service, you should use the V code specific to the vaccine given, instead of V20.2 (Routine infant or child health check). Using V20.2 at a catch-up-only encounter could incorrectly count toward the child's annual allotted preventive medicine services. On the claim, report:

- 90700 (Diphtheria, tetanus toxoids, and acellular pertussis vaccine [DTaP], when administered to younger than 7 years, for intramuscular use) for the DTaP supply

- 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]) for the DTaP injection

- V06.1 (Need for prophylactic vaccination and inoculation against combinations of diseases; diphtheria-tetanus-pertussis, combined [DTP] [DTaP]) linked to 90700 and 90471 to prove medical necessity for the vaccination

- 90657 (Influenza virus vaccine, split virus, when administered to children 6-35 months of age, for intramuscular use) for the flu vaccine

- +90472 (- each additional vaccine [single or combination vaccine/toxoid] [list separately in addition to code for primary procedure]) for the flu vaccine injection

- V04.81 (Need for prophylactic vaccination and inoculation against certain viral diseases; influenza) linked to 90657 and 90472 to prove medical necessity for the flu vaccination.