15 Feb 2016

Vaccine Administration CPT's coding guidelines

Vaccination is the administration of a vaccine (Is a biological preparation that provides active acquired immunity to a particular disease) to stimulate the immune system to protect the human body from the pathogen.

Regarding vaccine administration CPT codes, in 2011, two new CPT codes (90460 and 90461) were introduced to replace CPT 90465 – 90468.

The CPT codes 90460 – 90461 include physician counseling and are billed based on the number of components not by the number of vaccinations.

The CPT 90471 – 90474 is used when a physician does not counsel the patient on the vaccines administered.

Vaccine administration CPT codes are

         1.     CPT 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 the only component of each vaccine or toxoid administered

         2.     CPT +90461 –  each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure.
         3.     CPT 90471 - Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)

        4.     CPT +90472 –  each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure

        5.     CPT 90473 - Immunization administration by the intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid)

        6.     CPT +90474 –  each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)

To select appropriate administration codes, we have to look into the following things,
              1.     How many vaccinations were administered and what are the vaccines
              2.     What was the route of administration
              3.     How many components were there in each vaccine
              4.     Whether counseling was provided by the physician or not.

When two or more vaccines were administered, to bill each additional vaccine administration with +add on codes. Only one initial administration code can be used at a given encounter.

Eg: For 3 Intramuscular injections we have to use one primary admin and 2 units with add on code.
                        CPT 90471
                        CPT 90472 x 2

Eg: One Intramuscular injection and one oral administration

                        CPT 90471 (Intramuscular)
                        CPT 90474 (Oral)

Eg: Two intramuscular injections and one oral administration

                        CPT 90471 (First intramuscular)
                        CPT 90472 (Second intramuscular)
                        CPT 90474 (Oral)

Eg: One nasal and one oral

                        CPT 90473
                        CPT 90474

Vaccine with Counseling

Use CPT 90460 and 90461 Its responsibility of the coder to determine how many vaccines were administered, as well as how many components are contained in each vaccine.

CPT 90460 is for the first component and CPT 90461 is for each additional component

A component is an antigen that makes up the vaccine for a specific disease

All Vaccines include a minimum of one component Eg: Varicella virus vaccine (90716) its single component vaccine. If 2 vaccines are administered with counseling, CPT 90460 is billed twice.

Some vaccines have multiple components.  Eg: MMR (90707) its three components (Measles, Mumps and rubella virus vaccine)

Eg: Varicella and MMR

        CPT 90460 x2   (First components of both vaccines - Varicella and MMR)
        CPT 90461 x2   (Second and third component in MMR)

Eg: Hepatitis A, MMR and DtaP (Diphtheria, tetanus and acellular pertussis)

        CPT 90460 x3   (First components of three vaccines – Hep A, MMR and DtaP)
        CPT 90461 x4   (2nd and 3rd components of MMR and DtaP)

Note: CPT 90460 and 90461 is used only when the physician gives counseling to the patient/family during the administration of a vaccine. If counseling is not happening then use CPT 90471 to 90474.