Coding Vaccinations

First Healthcare Compliance Podcast- Healthcare Management Systems

Vaccinations are a hot topic for a lot of people. Particularly parents, who scour the internet, question the pediatrician, and talk with friends and family about the right path to take for their family.  Whatever that decision happens to be, it is important that it is documented. Not only is it important to be vigilant to new vaccine products and administration codes, it is also important to document the refusal of vaccines.

The importance of accurate vaccine coding, whether the vaccine was administered or refused, allows for the possibility for increased and/or appropriate payment and also it provides an accounting of services provided. ICD-9-CM contains codes that allow the physician to report vaccinations that have not been administered (ex:  V64.05 Caregiver refusal, V64.06 Patient refusal, V64.07 Religious reasons).

When coding vaccines/toxoids in CPT, it is necessary to code the administration and the product code.  The administration codes are 90460, 90461, 90471-90474.  The vaccine/toxoids product codes are 90476-90748 (90749 is an unlisted vaccine/toxoid).  If a physician or qualified health care professional provides face-to-face counseling of the patient/family during the administration of a vaccine, codes 90460 and 90461 should be used.  When the immunization is not accompanied by a face-to-face visit with a physician or qualified health care professional, then codes 90471-90474 should be utilized if the patient is over 18 years of age. Modifier 51 should not be utilized with vaccine/toxoid administration procedures.  E/M services performed at the same encounter should include the proper E/M service code.  Immunization registries, vaccine distribution programs, and reporting systems require the code or codes that identifies the exact product or products that were administered.  Remember to note the codes that are age specific.  There are separate codes available for combination vaccines.  Coding combination vaccines separately is not permissible.

The American Medical Association (AMA) uses the CPT Website to report new or revised vaccine product codes. Early release of CPT codes for vaccine products is intended to ensure that a CPT code is in place by the time a new vaccine product receives FDA approval.  They are posted January 1 and July 1.  Codes posted January 1 become effective July 1 and codes posted July 1 become effective January 1.  Codes that have not yet received FDA approval are designated with a “lightning bolt” symbol.  The AMA has a site available to view updated information about these codes.

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