CODING & DOCUMENTATION

 

Fam Pract Manag. 2019 Mar-Apr;26(2):31.

Author disclosure: no relevant financial affiliations disclosed.

CODING FOR IMMUNIZATION COUNSELING

Q

When I provide immunization counseling for three vaccines to a patient younger than 18, should I report CPT code 90460 for the first vaccine and 90472 for the second and third vaccines? This seems correct based on the CPT instruction that code 90472 may be used in combination with 90460.

A

No. Unless a payer requires other codes (as may apply under the Vaccines for Children program), when a physician (not clinical staff) provides and documents counseling for immunizations, you should report codes 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 component administered,” and 90461, “each additional vaccine or toxoid administered.” For example, for administration of measles, mumps, and rubella vaccine, you would report code 90460 once for the measles component and code 90461 twice — one time each for the mumps and rubella components. When reporting three separate vaccines, report 90460 three times – one time each for the first/only component of each vaccine and 90461 for each additional component.

Code 90472, “Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), each additional vaccine (single or combination vaccine/toxoid),” may be used in conjunction with code 90460 only when a physician provides counseling for one immunization and does not provide counseling for another immunization administered on the same date. This could occur if the patient received counseling on a prior date when an initial dose was administered or an immunization was refused.

When no physician counseling is provided on a date when multiple immunizations are provided, report either immunization administration

ABOUT THE AUTHOR

Cindy Hughes is an independent consulting editor based in El Dorado, Kan., and a contributing editor to FPM.

Author disclosure: no relevant financial affiliations disclosed.

WE WANT TO HEAR FROM YOU

Send questions and comments to fpmedit@aafp.org, or add your comments below. While this department attempts to provide accurate information, some payers may not accept the advice given. Refer to the current CPT and ICD-10 coding manuals and payer policies.

 
 

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