Re: Re: Children's Vaccines-long post

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90465 is the code, 90466 for any additionalvaccines. Here's a source: http://www.aap.org/visit/OverviewImmunizationAdmin2006.pdfNOn Oct 24, 2006, at 8:47 PM, freethinker4 wrote:Yes. I didn't have the codes at hand. They were initiated in 2005. These codes give additional reimbursement for "counselling" forvaccines in children under age 8 years.This is copied from a password protected portion of the AAP website. One can charge a higher fee for tis counselling. Simply show the VISfor each vaccine the patient receives, then ask if there are anyquestions. Talk about the basic, common side effects of the vaccineswhile in the visit. The parent reads the VIS sheets while you draw upand document the vaccines in your log (or your patient does). Ask ifthere are any questions. You answer questions = you provide thecounselling. If nurse/MA gives shot and there are any questions, goback in and answer those questions. Have the parent sign in the chartat the appropriate place. There you go.The VIS pages can be printed out for free from www.cdc.gov and theyare also availible in Spanish.Common side effects;DTaP Fever/swelling at injection site about 10-15% Very rare seriouseffects in the newer vaccine--in the VIS--let them ask questionsPCV Fever/swelling at injection site about 10-15%IPV No significant side effectsHIB No serious side effects. Occasional mild feverPediarix--combines DTaP/IPV/HBV--use component VISHBV No significnt side effectsHAV "The disease that closed Chi Chi's in Pittsburgh" works foreveryone in PennsylvaniaRotateq--diarrhea, occasional. I also explain the improvements overthe previous rotavirus vaccine.Tdap see DTaPMenactra--darn, I am uncomfortable here. It isn't cost effective andthere have been 17 reported cases of Guillaine-Barre syndrome afterthis vaccine.Gardasil--we don't have it yet, but the mothers beg for it. Really.MMR/MMRV/Varicella--I explain latent period of live viral vaccines andviral illnesses in general--the fever/rash side effects may occur 5-15days after the vaccine. I let them know that there ar exremely rareside effects to the measles component but let them read about them andask questions if they want after. Not too many are worried aboutautism, but when they are I addresss it directly. Thimerosal--no vaccine except influenza > 3yrs has any appreciableamount of thimerosal in it. I love debunking parents on this--thethimerosal was taken out 5 years ago. It puts a hole in their trustabout their anti-medicine internet websites.Here we go, from the AAP website:AAP Committee on Coding and NomenclatureThe Academy recently was successful in obtaining four newpediatric-specific immunization administration CPT codes, which willbecome effective on Jan. 1, 2005 (CPT 2005). The codes will be modeledon the four existing immunization administration codes with twospecific reporting requirements:1. The patient must be under 8 years of age; and2. The physician must provide the vaccine counseling.If both of these requirements are not met (e.g., the patient is 6years old but a nurse does the vaccine counseling), then theappropriate existing immunization administration code (90471-90474)will be reported instead.The new codes are:* 90465 Immunization administration under 8 years of age (includespercutaneous, intradermal, subcutaneous or intramuscular injections)when the physician counsels the patient/family; first injection(single or combination vaccine/toxoid), per day. (Do not report 90465in conjunction with 90467.)* 90466 Each additional injection (single or combinationvaccine/toxoid), per day. (List separately in addition to code forprimary procedure.) (Use 90466 in conjunction with 90465 or 90467.)* 90467 Immunization administration under age 8 years (includesintranasal or oral routes of administration) when the physiciancounsels the patient/family; first administration (single orcombination vaccine/toxoid), per day. (Do not report 90467 inconjunction with 90465.)* 90468 Each additional administration (single or combinationvaccine/toxoid), per day. (List separately in addition to code forprimary procedure.) (Use 90468 in conjunction with 90465 or 90467.)The new codes are listed in the CPT manual just prior to the existingimmunization administration codes (90471-90474) in the beginning ofthe Medicine Section. With the addition of the four newpediatric-specific codes, CPT 2005 now contains a total of eightimmunization administration codes.The following vignettes demonstrate the appropriate reporting of thenew codes.Vignette #1A 5-year-old patient receives the varicella vaccine and the intranasalinfluenza vaccine in conjunction with his preventive medicine visit.The physician conducts the vaccine counseling associated with bothvaccines. The immunization administration for this visit is reportedas follows:* 90716 Varicella virus vaccine, live, for subcutaneous use* 90465 Pediatric-specific immunization administration; firstinjection* 90660 Influenza virus vaccine, live, intranasal use* 90468 Pediatric-specific immunization administration,oral/intranasal; each additional administrationThe preventive medicine visit and any other services provided duringthe encounter would be reported separately.Vignette #2A 5-year-old patient receives the varicella vaccine and the intranasalinfluenza vaccine in conjunction with his preventive medicine visit.The nurse conducts the vaccine counseling associated with bothvaccines. The immunization administration for this visit is reportedas follows:* 90716 Varicella virus vaccine, live, for subcutaneous use* 90471 Immunization administration; one vaccine* 90660 Influenza virus vaccine, live, intranasal use* 90474 Immunization administration, oral/intranasal; eachadditional vaccineThe preventive medicine visit and any other services provided duringthe encounter would be reported separately.Vignette #3A 9-year-old patient receives the varicella vaccine and the intranasalinfluenza vaccine in conjunction with his preventive medicine visit.The physician conducts the vaccine counseling associated with bothvaccines. The immunization administration for this visit is reportedas follows:* 90716 Varicella virus vaccine, live, for subcutaneous use* 90471 Immunization administration; one vaccine* 90660 Influenza virus vaccine, live, intranasal use* 90474 Immunization administration, oral/intranasal; eachadditional vaccineThe preventive medicine visit and any other services provided duringthe encounter would be reported separately.Code valuationThere is good indication that the new codes will be valued forphysician work on the 2005 Medicare Physician Fee Schedule orResource-Based Relative Value Scale (RBRVS). If this happens, it willbe the first time in the history of the immunization administrationcodes that the Centers for Medicare & Medicaid Services (CMS) hasrecognized the physician work involved in administering vaccines inthe pediatric population. It also will raise the total relative valueunits (RVUs) significantly, resulting in higher reimbursement fromnon-Medicare carriers that follow RBRVS in determining their feeschedules.It will not be known for certain what the published RVUs for the newcodes will be until CMS releases the 2005 RBRVS final rule inNovember. The projection is between 0.30 and 0.38 total RVUs, whichcalculates to $11.37 to $14.40 per administration using the projected2005 Medicare conversion factor ($37.8975).--- In , Rocky Patel wrote:>> Can you be more specific regarding cpt codes you are using for> counseling?> > rocky> > --- freethinker4 wrote:> > > I'm a pediatrician that has always been in an employed situation> > looking to go solo-solo which is why I joined this group. In my> > first> > practice, we all drew up and gave our own shots. It wasn't hard,> > actually and it gave the parents time to think if there were any more> > questions.There were a lot less back then though as well as virtually> > no documentation requirements.> > > > Some tips and pointers. Get a refrigerator that has a separate> > freezer component. Fill the freezer with every ice pack you can> > find--it keeps it much colder. You can get these ice packs> > free--they> > come with every vaccine order. We only need two freezer shelves for> > vaccines and our freezer is completely full. I'm not positive, but I> > think one of the vaccine companies will give you good> > refrigerator/freezer thermometers. The thermometer is digital and> > magnetically attaches to the front door. We have one for the fridge> > and one for the freezer. We log the refrigerator temperature and> > freezer temperature AM and PM. If either is out of range we re-log> > 20> > minutes later.> > > > We keep separate supplies of VFC and private vaccine. They are> > easily> > identified by circular colored labels, one with a $ and one with VFC.> > > > Vaccines can be profitable with the newer CPT codes for giving> > vaccines under age 7. These codes refer to counselling for the> > vaccines (Give pt a VIS sheet to read and have them sign it => > counselling. We keep our VIS sheets in a binder--we don't hand them> > out, saves a lot of money as well as ink and paper.) They carry> > substantially increased reimbursement.> > > > More and more pediatric vaccines are coming out in prefilled> > syringes--Prevnar, Pediarix, and flu for the 3 and under crowd--saves> > time and syringes.> > > > Hope this helps.> > > > > > >> > > Vaccines are a hassle (for a variety of reasons) I'm trying to get> > better> > > organized about. Some on the list seem to have done well pricewise> > by> > > shopping around and getting better prices from different sources.> > > Personally I've tried to keep it simple for now and order them> > through my> > > McKesson rep except for those one must get directly from the> > manufacturer.> > > I've got to keep track of the supply on hand better as a few times> > I've> > > wanted to give a shot and at the last minute realized I hadn't> > ordered a> > > new batch -- other day I gave Pediarix and Prevnar to a 2 month old> > but> > > didn't have Hib so I'm ordering it and will have to bring her back> > in a> > > week or two... I don't think the parent cared (I've known the> > family a> > > long time so trust is there) but honestly I am tougher on myself> > than> > > others are on me most of the time.> > > > > > Anyway, getting a good frig/freezer without paying through the nose> > is> > > important. Then you gotta keep track of the temp... I'm considering> > > getting the thermometer discussed a couple months ago that follows> > the> > > average temp better than the simple ones I got now that I have to> > check by> > > opening the doors.> > > > > > Then you must consider the upfront costs and hope the insurers pay> > well> > > enough.> > > > > > So, yeah, it can be a hassle and everyone has to plan how they deal> > with> > > vaccines. Convenience for patients/families is important as having> > them> > > go to health department shots clinics may be an option but likely> > > increases the risk kids will be behind in shots, etc.> > > > > > I'm sure others on the list will have good pointers and most of> > them> > have> > > more experience behind them than I do (open just 7 months).> > > > > > Overall I like giving shots ... and I think it's funny when a> > patient says> > > something like, "I didn't know you could give a shot", which has> > happened> > > a couple times! To think there are things only nurses do and> > doctors> > > can't is interesting to me, but I guess that is what the medical> > world has> > > shaped over the years since patients simply don't see the doc doing> > such> > > things most of the time. Patients have made similar comments when> > I> > take> > > vital signs too.> > > > > > Good luck with your plans down in Duchess County... pretty area.> > > Tim> > > > > > > I recently joined your group and have been learning alot from> > reading> > > > the posts. I am planning to join a solo doc in Dutchess County,> > > > NY,in a few months with the idea of taking over his practice in> > the> > > > next year or so. I would say he meets the type of practice you> > all> > > > follow: he is by himself with a part-time front desk person.> > > > He currently limits his practice to 5 year olds and up. He says> > > > vaccines are the issue for younger children. I was wondering what> > you> > > > guys are all doing in terms of vaccines. The town his practice> > is in> > > > does not have any providers for infants/toddlers so I was hoping> > this> > > > could be a market to capture (plus I love seeing kids). I could> > see> > > > how vaccines could affect this in terms of cost to buy,> > storage/upkeep> > > > issues, time to administer without nursing help, etc. Thanks for> > any> > > > help on this issue. I am sure I will have plenty of more> > > > questions/calls for help in the next few months.> > > > Margaret Coughlan M.D.> > > >> > > >> > > >> > > >> > > >> > > >