You’ll soon capture counseling per disease.
For combination vaccines that may involve counseling on as many as five different diseases, getting paid as though you counseled on one never seemed fair, but CPT 2011 lets you capture that extra counseling work.
Although multiple component vaccines require counseling on each disease, physicians have only been able to capture counseling for vaccine administration once per administration. CPT 2011 solves the problem with new immunization administration with counseling codes that you’ll code per vaccine component.
CPT 2011 deletes 90465-90468 (Immunization administration younger than 8 years of age … when the physician counsels the patient/family … per day). Codes 90471-90474 (Immunization administration …) remain.
Use 90460 as Vaccine Administration With Counseling Base Code
No more looking at administration route when choosing which immunization administration with counseling code. For vaccine administration, you’ll assign one code for each vaccine’s initial component:
- 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.
Definition: A component refers to the antigen in a vaccine that prevents disease caused by one organism.
CPT streamlines your coding of the vaccine counseling codes by giving you one universal base code. The code includes “any route of administration.” You no longer have to choose a different code based on whether the code is intramuscular/subcutaneous or oral/intranasal.
Step 2: Report Second Vaccine Component With +90461
Coders can breathe a sigh of relief as the complexities over deciding which 90465-90468 code to use as the base code will soon end. CPT 2011 gives you only one vaccine administration with counseling base code (90460). For each additional vaccine component, you report the same add on code:
- +90461 — Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (List separately in addition to code for primary procedure).
If the physician, nonphysician practitioner (NP), physician assistant (PA), or other healthcare qualified professional provides vaccine counseling to a patient less than 19 years old for a second disease/component, you’ll assign +90461 for the second vaccine component. You will always report +90461 in addition to 90460.
Step 3: Use Units to Report 3+ Administrations
You’ll keep using the same add-on code, +90461, for each additional vaccine component. Bill the add-on code, plus the number of units that represents the number of components.
Example: A pediatrician counsels a mother on vaccine risks and benefits prior to giving the patient Pediarix, which has five components: DTaP-HepB-IPV. The diphtheria, tetanus toxoids, acellular pertussis each count as one component, plus Hepatitis B and inactivated polio virus each count as one. For the vaccine administration with counseling on the components included in Pediarix (90723), using CPT 2011 codes, you should report:
- 90460
- +90461 x 4.
Stay tuned to Pediatric Coding Alert and CodingNews for more facts you need on correct CPT 2011 vaccine immunization code use.
