Wiki 90460 and 90461

[ALLIE1]

Can some one share with me the reimbursement for 90460 and 90461 they are recieving? If coded correctly we are getting reimbursed for 90460 at the full rate we billed 20.00. They are deying the 90461 as inclusive to 90460. Even after an appeal we do not get any additional money on 90461. Thanks!

 

[Sanjit]

When reporting codes 90460 and 90461, each component of a particular vaccine should be coded. Further instructions for use of these codes is provided in the CPT Changes 2011 publication. For vaccines with multiple components [combination vaccines], code 90460 is reported in conjunction with 90461 for each additional component in a given vaccine. Since a vaccine may be comprised of multiple flu strains with the influenza vaccine being a single component vaccine, it would not be appropriate to additionally report code 90461.

Please see the following chart:

Vaccine.........................No. of Vaccine Components...................Immunization Administration Code(s)
HPV : ...................................... 1:...................................................... 90460
Influenza : ................................ 1: ......................................................90460
Meningococcal:..........................1:.......................................................90460
Pneumococcal:..........................1:.......................................................90460
Td : .........................................2:.......................................................90460, 90461
DTaP or Tdap:...........................3:...................................................... 90460, 90461, 90461
MMR:.........................................3:.......................................................90460, 90461, 90461
DTaP-Hib-IPV (Pentacel):...........5:....................................................... 90460, 90461, 90461, 90461, 90461
DTaP-HepB-IPV (Pediarix:..........5:........................................................90460, 90461, 90461, 90461, 90461
DTaP-IPV (Kinrix):.....................4:........................................................90460, 90461, 90461, 90461
MMRV (ProQuad) :....................4:........................................................90460, 90461, 90461, 90461
DTaP-Hib (TriHIBit):...................4:....................................................... 90460, 90461, 90461, 90461
HepB-Hib (Comvax):.................2:....................................................... 90460, 90461
Rotavirus:.................................1:........................................................90460
IPV:...........................................1:.......................................................90460
Hib:...........................................1:.......................................................90460

For additional information please refer to: http://www.supercoder.com/articles/...ry-widely-on-how-to-report-new-vaccine-codes/

Sanjit K Mishra, CPC
SuperCoder