Wiki Vaccine Counseling

[dballard2004]

I want to start off by saying that I completely understand how to correctly report the new pediatric vaccine administration codes (90460/90461), but I do have an additional question that has come up.

What if a patient presents to the clinic for a combination vaccine (Tdap), but the physician only counsels regarding the first component only (tetanus) and not the other two components? How would this be coded?

I am thinking we would only report 90460 since this is for each vaccine administered and Tdap is only one vaccine, but I would like other opinions as well. Thanks.

 

[jettman]

I want to start off by saying that I completely understand how to correctly report the new pediatric vaccine administration codes (90460/90461), but I do have an additional question that has come up.

What if a patient presents to the clinic for a combination vaccine (Tdap), but the physician only counsels regarding the first component only (tetanus) and not the other two components? How would this be coded?

I am thinking we would only report 90460 since this is for each vaccine administered and Tdap is only one vaccine, but I would like other opinions as well. Thanks.

Interesting question. I think I would report 90460 for the Tetanus vaccines (counseled), and 90472 for the diphtheria and acellular pertussis vaccines (non-counseled).

I'm basing my answer on an AAP Coding newsletter from November, 2010, where they give a similar scenario: MMRV with counseling (90460) and DTaP-IPV (90696) without counseling (90472). In the same article the AAP also says "There are no current CPT guidelines restricting the reporting of codes 90471 - 90474 in conjunction with codes 90460 and 90461."

It would be interesting to see what payers would do with this scenario.

Best,
Jettman

 

[dballard2004]

Thanks so much. I too am interested in how this will play out with payers.

 

[Codeling]

The problem with that is that 90472 is for "each additional vaccine" not each additional component.

For example, if MMR and Pentacel were administered without counseling it would be coded as 90471 and 90472; therefore, I don't see why it would be just to code 90460, 90472, and 90472 for MMR with counseling on one out of three of its components.