New Coding for Administration of Immunization for 2011

November 15th, 2010

Effective January 1, 2011, immunization codes 90465-90468 will be gone. 

Replacing them are new codes 90460 and add-on code 90461.   The new codes recognize the counseling given to pediatric patients and their families concerning the risks and possible side effects of the immunizations.

Counseling may be given by the physician or qualified health care professional such as a nurse practitioner or a physician assistant at the time of service.  Registered nurses and medical assistants are not qualified health care professionals.  Counseling provided by them do not qualify for 90460 and 90461.

Compliance Alert:  Be sure to record a note about the counseling component associated with immunization as these are component of the CPT code definition.  Also, avoid charging a separate evaluation and management code for the visit unless significant, medically necessary services are provided.

Per CPT, the new codes are defined as:


90460 - Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component.

+90461 each additional vaccine/toxoid component (List separately in addition to code for primary procedure)

If counseling is NOT provided, codes 90471 through 90474 should be used instead.

Codes 90460 and add-on code 90461 are reported per vaccine or toxoid component. Per CPT notes a component is a single antigen in a vaccine that prevents disease caused by a single organism.  Thus if a vaccine contains multiple antigens, the vaccine is a combination vaccine.

Multiple units of code 90460 may be reported for each first vaccine or toxoid component administered. No modifier should be required when reporting multiple first components.   90460 applies to combination vaccines and to single component vaccines such as influenza. Code 90461 is an add-on code reported for each additional vaccine component administered.

Modifiers are not required for multiple vaccines.

Coding Example:

The following example of the use of the new administrative codes is from the AAFP website:

An 11-year old girl presents for a preventive visit (99393). In addition, the child and her mother are counseled by the physician on risks and benefits of HPV (90649), Tdap (90715) and seasonal influenza administers each vaccine, completes chart documentation and vaccine registry entries, and verifies there is no immediate adverse reaction.

CPT Codes reported are:
99393 - Preventive Service
90649 - HPV vaccine
90460 - Administration first component (1 unit)
90715 - Tdap vaccine
90460 - Administration first component (1 unit)
90461 - 2 additional components (2 units)
90660 - Influenza vaccine, live, for intranasal use
90460 - Administration first component (1 unit)

 

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