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.