Codes 90476-90748 identify the vaccine product only. To report the administration of a vaccine/toxoid, the vaccine/toxoid product codes 90476-90749 must be used in addition to an immunization administration code(s) 90460-90474
J1670 is injection of tetanus immune globulin (TIG), human, up to 250 units but this may not be needed if wound <24 hours old. Tetanus immune globulin provides a passive immunity for injuries that are over 24 hours old, for injuries that are extensively contaminated, and for clients who have had fewer than 2 tetanus toxoid injections in a lifetime. Therefore, both procedure codes 90703 and J1670 can be given on the same day, for the same injury event.
After an acute penetrating or invasive injury, prevention of tetanus is accomplished through appropriate wound cleansing and debridement and the administration of human TIG, when indicated. TIG is indicated for prophylaxis against tetanus following an acute penetrating or invasive injury in a client whose immunization is incomplete or uncertain.
So you should bill for the E&M with the shot(s) and administration of the shot(s).