Wiki Delayed Vaccine Counseling

[emourer]

With the current political climate and social media disinformation, we have had an increase in vaccine hesitancy within our patient population which has created more alternate/delayed vaccine schedules. Patients on a delayed schedule are asked to come back for a follow up visit with their PCP to discuss and counsel on previous vaccine not carried out. Our physicians are wanting to bill for an E/M visit based on counseling time, the vaccine carried out, and the counseling administration of said vaccine. Based on coding guidelines, in a case like this, the E/M would not be significant/separate from the vaccine counseling admin (90460-90461) and therefore not appropriate to bill with the 25 modifier. I'm looking for other coders thoughts/perspective on this scenario?? Thank you in advance!!

 

[Cynthia Hughes]

If there is not significant and separately identifiable E/M service beyond vaccine counseling with same date administration, there is no separately billable E/M service.
For services provided in 2026, the opportunity to bill for immunization counseling on a date when immunizations are not administered may be possible. See codes 90482-90484 that specifically report immunization counseling without same date administration but be aware that some payers may not include these as separately payable services. Also, see codes G0310-G0315 (effective in 2025 and 2026) for possible alternative codes for immunization counseling. If you are not familiar with the G codes, there is an article published by the AAFP that links to a CMS letter explaining their intended uses https://www.aafp.org/pubs/fpm/blogs/gettingpaid/entry/vaccine_counseling_codes.html.

I hope this is helpful.
Cindy