CPT Code Updates for 2011

New Pediatric Vaccine Administration Codes Include Counseling Time

November 30, 2010 04:30 pm Sheri Porter

The annual revision of the AMA's CPT manual holds some positive changes for family physicians and their pediatric patients. Of particular interest are new CPT codes for reporting administration of vaccines to children.

Specifically, the AMA's CPT 2011 says that as of Jan. 1, physicians can use CPT codes

  • 90460 -- for administration of immunizations to children through age 18 via any route of administration, with counseling provided by a physician or other qualified health care professional for the first vaccine or toxoid component; and
  • +90461 -- for each additional vaccine or toxoid component that is listed separately and is in addition to the code for the primary procedure.

CPT defines a "component" as each antigen in a vaccine that prevents disease caused by one organism; combination vaccines contain multiple vaccine components.

Cynthia Hughes, C.P.C., an AAFP coding expert, called the updated codes for pediatric vaccines an encouraging step. She said current code structures promote physician administration of individual vaccines and the reporting of multiple administration services. "Physicians are simply trying to recover the expenses they accrue when providing vaccines to patients," said Hughes.

The new pediatric vaccine administration codes take into account the professional time required to counsel parents or caregivers of children receiving the vaccine. That counseling includes an explanation of each component of a multiple-component vaccine. "The higher payment is intended to cover the cost of the physician's time to do that counseling," said Hughes.

The new CPT codes also will benefit families because combination vaccines cut down on the discomfort children face from multiple needle sticks and medical office encounters. "Any decrease in the number of required shots likely will encourage parents to get the recommended pediatric immunizations on schedule and increase compliance rates," said Hughes.

The AAFP has created new online resources to help family physicians code services accurately to receive appropriate payment.

And to ensure physicians aren't tripped up by nuances of the new codes, Hughes provided tips for their usage. For example, the new codes

  • are limited to immunization administration (vaccines must be separately reported);
  • require a face-to-face visit so a physician or other qualified health professional can deliver the required counseling;
  • call for use of CPT code 90460 to report each separate administration of a single-component vaccine or the first component of a combination vaccine; and
  • allow for the use of CPT code 90461 for each additional component of a combination vaccine.

Hughes pointed out that in the case of combination vaccines, the modifier "-51" still is not required. She also assured physicians that the new codes cover vaccines that are administered by injection, orally or intranasally.

Additional CPT code changes for 2011, including how to report patient observation; time spent providing a service; maternity care; noninvasive vascular studies; incisions, excisions and debridement; and unattended sleep studies, will be reviewed in the January issue of the AAFP journal Family Practice Management.