Primary Care Coding Alert

Question: A 16-year-old female patient recently came into our office for a routine flu immunization, which was administered by one of our nurses. Should we code this as 90460, or is 90471 a more accurate code to use for this service?

Ohio Subscriber

Answer: There are two main differences between 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 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]). The first is the age component: 90460 is restricted to patients up through the age of 18, which would include your patient, whereas 90471 is open-ended regarding age.

But that does not mean 90460 is the best code to use in this scenario. The second significant component of 90460 states that the service must be accompanied by “counseling by physician or other qualified health care professional.” Your description of the encounter does not mention whether this occurred during the visit. Given that this was for a routine immunization, there is a good chance it did not, so 90471 would be the most appropriate code to use under those circumstances.

However, if your physician or other qualified health care professional (for example, a nurse practitioner) did counsel your patient, go ahead and use 90460 for the service.