CPT 2011 / Hot Coding Topics

CPT 2011: Vaccine Product to 90460, 90461 Crosswalk

How to count components for Boostrix, Pediarix – and other immunizations.

Excited by the new vaccine administration codes’ payment per component but not sure how many components specific vaccines have? This chart does the work for you.

Find the product name for a quick cross reference to how many components the vaccine includes and the administration with counseling code combination to report using the new pediatric/adolescent codes.

Note: The ICD-9 vaccine product code listed in the chart uses the generalized vaccine product code (V06.8, Need for prophylactic vaccination and inoculation against other combinations of diseases). For vaccine administration provided outside of a preventive medicine service, the American Academy of Pediatrics recommends using V06.8 for combination vaccines that do not have their own individual single ICD-9 code.

Vaccine Product Manufacturer Components CPT Product Code Number  of Components CPT 2011 Administration with Counseling Code ICD-9-CM 2011 Code
ActHIB Sanofi Pasteur Hib 90648 1 90460 V03.81
Adacel Sanofi Pasteur Tdap (tetanus- diphtheria-acellular pertussis) 90715 3 90460, +90461 x 2 V06.1
Boostrix GlaxoSmithKline Tdap 90715 3 90460, +90461 x 2 V06.1
Cervarix GlaxoSmithKline HPV 90650 1 90460 V04.89
Comvax Merck HepB-Hib 90748 2 90460, +90461 V06.8
Daptacel

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January 7, 2011
CPT 2011 / Hot Coding Topics / Multiple component vaccines

CPT 2011: Goodbye 90465-90474, Hello Vaccine Administration Component Coding

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

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November 9, 2010