CPT 2011 Bids Goodbye to 90465-90474, Welcomes Hello Vaccine

CPT 2011 Bids Goodbye to 90465-90474, Welcomes Hello Vaccine

For combination vaccines that may involve counseling on as many as five different diseases, getting paid as though you counseled on one never seemed right, however CPT 2011 lets you capture that extra counseling work.

Multiple component vaccines (Pentacel, Kinrix, MMRV) have had an economic disincentive related to the loss of immunization administration codes with these vaccines.

As the present CPT vaccine administration codes (90465-90467) are coded per vaccine, the codes capture payment for only one counseling administration code.

CPT 2011 will delete 90465-90468. The 90471-90474 (Immunization administration ...) codes will remain.

Good news: In the coming year, you will report the immunization administration with counseling codes per component. Here's how:

Step 1: Report 90460 as vaccine adminstration W/ counseling base code

You shouldn't look at administration route when selecting which immunization adminstration with counseling code. For vaccine administration except for H1N1, you'll assign one code for each vaccine's initial component: 90460.

Step 2: Use second vaccine component with +90461

Pediatric coders can heave a sigh of relief as the complexities over deciding which 90465-90468 code to use as the base code will soon end. The CPT codes 2011 for the coming year give you only one vaccine administration with counseling base code (90460). You will report the same add on code for each additional vaccine component: +90461.

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 will 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 will keep using the same add-on code, +90461, for each additional vaccine component. Bill the add-on code, in addition to the number of units that represents the number of components.

For more information on CPT 2011 and the entire CPT code list, sign up for a medical coding guide like Supercoder!

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