Wiki Vaccine Administration Question

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Schellie

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South Ogden, UT
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The company I work for have been using 90471, 90472 and 90473 or 90474 for vaccine administration is this correct? Or should we be using 90460 and 90461? Our EMR is throwing out this error all of the sudden about the 90471 and 90472 should be 90460 and 90461. Just clarifying for myself and the company.
 
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Schellie said:
The company I work for have been using 90471, 90472 and 90473 or 90474 for vaccine administration is this correct? Or should we be using 90460 and 90461? Our EMR is throwing out this error all of the sudden about the 90471 and 90472 should be 90460 and 90461. Just clarifying for myself and the company.
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If you use 90460 & 90461 the provider must provide counseling for the vaccine(s) and it needs to be documented that it was done. 90460 & 90461 are only to be used for patients under 18yrs. If counseling isn't provided then 904_ _ codes are appropriate.
 
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Schellie said:
I guess I should have clarified this is for a pediatric clinic. That was my bad
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I work in an Internal Medicine & Pediatrics clinic and code & bill pediatric vaccines daily, 90460 & 99461 require counseling to be done. There must be documentation stating that provider did vaccine counseling.
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.
 
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What would you do if your employer makes you code 90460 and 90461 for every patient for every immunization? The template for our will visits says that counseling is done every time, but I know it is not. They are noticing the $2 change in payment when we use 90471 and 90472. How would you proceed?
 
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Getting similar rejections via my clearinghouse. It states "Procedure 99391 is included with procedure 90460 on the current or previously submitted claim. Under appropriate circumstances, a designated modifier may be allowed to identify distinct services." There may have been a modification to include vaccine administration to 99391description. I going to add modifier 25 to the 99391 for my rejected claims.
 
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Sbest said:
Getting similar rejections via my clearinghouse. It states "Procedure 99391 is included with procedure 90460 on the current or previously submitted claim. Under appropriate circumstances, a designated modifier may be allowed to identify distinct services." There may have been a modification to include vaccine administration to 99391description. I going to add modifier 25 to the 99391 for my rejected claims.
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99391 does need modifier 25 since you are also billing for 90460 which is administration of vaccine with counseling done by provider.
 
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rthomas@impcna.com said:
If you use 90460 & 90461 the provider must provide counseling for the vaccine(s) and it needs to be documented that it was done. 90460 & 90461 are only to be used for patients under 18yrs. If counseling isn't provided then 904_ _ codes are appropriate.
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I guess I should have clarified this is for a pediatric clinic. That was my bad
 
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