Primary Care Coding Alert

Question: Rotavirus vaccine is only given to children less than the age of eight at 2,4, and 6 months and is given orally. I believe we should only ever use administration codes ‘90460’ and ‘90461’ oral administration for persons less than 8 years of age. Alternatively, could 90473 or 90474 apply?

New Jersey Subscriber

Answer: While codes 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered) and +90461(…each additional vaccine or toxoid component administered [List separately in addition to code for primary procedure]) apply only to patients18 years of age or younger -- that is not the sole requirement for using these two codes. The physician or other qualified health care professional (e.g., NP or PA) must have provided vaccine counseling and documented the counseling in the chart.

If the FP provides -- and documents -- vaccine counseling, you would be correct in using 90460 or 90461 for the administration of the Rotavirus vaccine. However, without physician or other qualified health care professional (e.g., NP or PA) vaccine counseling, Rotavirus administration would fall under either 90473 (Immunization administration by intranasal or oral route; 1 vaccine [single or combination vaccine/toxoid]) or 90474 (…each additional vaccine [single or combination vaccine/toxoid component][List separately in addition to code for primary procedure]).

So, based on whether your FP provides counseling or not when administering the Rotavirus vaccine, you can choose to report either 90460/90461 or 90473/90474.Whether you report the first or second code in each pair will depend on whether the Rotavirus vaccine was the only/first vaccine administered (90460 or 90473) or an additional vaccine administered (90461 or 90474) at the same encounter as another vaccine(s).

In any case, be sure to also report the code for the Rotavirus vaccine itself, if it represents a cost to your practice. There are two codes for Rotavirus vaccine product: 90680 (Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use) and 90681 (Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use). Since you indicated a 3-dose administration schedule, the appropriate code would be 90680.