Re: 2011 Pediatric Immunization Administration Codes - updated - confusing

January 28, 2011

I looked at a fee schedule for one of my local insurers and the new ones seemed

to pay the same as the 90471/72 ones so I was not going to bother yet with them.

Margaret Coughlan

2011 Pediatric Immunization Administration Codes

- updated - confusing

Â

Anybody hep on this?

I've been using 90471 and 90472 for vaccine admin for years - for kids and

adults.

I remember when the fancy kids admin codes came out...

â€¢

90465 - Immunization administration under 8 years of age (includes percutaneous,

intradermal, subcutaneous or intramuscular injections) when the physician

counsels the patient/family; first injection (single or combination

vaccine/toxoid), per day.Â (Do not report in conjunction with 90467)

â€¢

90466 - Each additional injection under 8 years of age (includes percutaneous,

intradermal, subcutaneous or intramuscular injections) when the physician

counsels the patient/family; (single or combination vaccine/toxoid), per day.Â

List separately in addition to code for primary procedure.Â (Use in conjunction

with 90465 or 90467)

â€¢

90467 - Immunization administration under 8 years of age (includes intranasal or

oral routes of administration) when the physician counsels the patient/family;

first administration (single or combination vaccine/toxoid), per day.Â (Do not

report in conjunction with 90465)

....but I didn't use them because - -in the past they didn't pay any more than

the old 90471/2 and some insurances didn't recognize them initially, plus it was

just that much more confusing. Although, in theory, I recall that they were

supposed to pay more by covering the extra time spent on counseling

patients/parents about the vaccines.

Now I see the new codes are replacing the above codes -- see article below.

But it seems that the old codes (90471 and 90472) are still being used? Even for

kids shots?

Does anyone have a grasp on this?

Can I continue to muddle along and click on 90471 and 2 for all my shots -

including kid's shots?

========================================

Excellent review of the changes below...go to the link...

Â Â Â Â http://practice.aap.org/content.aspx?aid=2980

2011 Pediatric Immunization Administration Codes

The American Academy of Pediatrics (AAP) developed new Current Procedural

Terminology (CPT Â® ) codes for reporting immunization administration in the

pediatric patient population. The new codes become effective on January 1, 2011,

and will replace codes 90465â€“90468.

snip/snip

========================================

Other articles that just seem to show how confusing (to me at least) the new

coding is...

http://www.ncdhhs.gov/dma/bulletin/0111bulletin.htm#imm

http://www.aafp.org/online/en/home/practicemgt/codingresources/immunizations/adm\

incodingchanges2011.html

Need a login --

http://www.aafp.org/fpm/2011/0100/p5.html?aafpvlogin=0026282 & aafpvpw= & URL_succes\

s=http%3A%2F%2Fwww.aafp.org%2Ffpm%2F2011%2F0100%2Fp5.html

NUMBER OF COMPONENTS IN COMMON PEDIATRIC VACCINES

Number of components One Two Three Four Five

Vaccine administration code(s) 90460 90460, 90461 90460, 90461 x 2 90460, 90461

x 3 90460, 90461 x 4

Vaccine

Hepatitis A (HepA)

Hemophilus influenza type B- hepatitis B (Hib-HepB)

Diphtheria-tetanus- pertussis (DTaP)

Measles-mumps- rubella-varicella (MMR-V)

Diphtheria-tetanus- pertussis, hepatitis B, inactivated poliovirus

(DTaP-HepB-IPV)

Hepatitis B (HepB)

Measles-mumps- rubella (MMR)

Diptheria-tetanus- pertussis, Hemophilus influenza type B, inactivated

poliovirus (DTaP-Hib-IPV)

Human Papilloma virus (HPV)

Tetanus-diphtheria- pertussis (Tdap)

Inactivated poliovirus (IPV)

Influenza virus

Meningococcal conjugate vaccine (MCV)

Pneumococcal conjugate vaccine (PCV)

Rotavirus (RV)

Varicella virus

=======================================

http://blogs.aafp.org/fpm/gettingpaid/entry/a_little_good_news_for

Getting Paid

Â« The 2011 Medicare... | Main | SGR relief: Let us... Â»

Wednesday Nov 17, 2010

Vaccine administration: A little good news for little folks and their doctors

If you provide pediatric vaccines in your practice, you have no doubt noticed

the increase of combination vaccine products and a related decrease in your

payment for vaccine administration services. The good news is that the CPT

Editorial Panel and the Centers for Medicare & Medicaid Services (CMS) also

noticed. New codes will allow reporting of the administration service for each

vaccine component beginning in 2011. Even better, CMS published relative value

units (RVUs) for these codes â€“ even though they will not typically be reported

for Medicare patients.

The new codes are 90460 and 90461. These codes should be reported for physician

counseling (or that ofÂ another qualified health care professional)Â and

administration of vaccines to children through age 18. Code 90460 is reported

for administration of a single component vaccine and/or for the first component

of a multiple component vaccine. Code 90461 is reported for each additional

component of a multiple component vaccine. For example, MMR vaccine has three

components, so administration of this vaccine would be reported with one unit of

90460 and two units of 90461.

CMS assigned RVUs to these codes by crosswalking them with the values of the

adult vaccine administration codes 90471 and 90472. This means that new code

90460 has the same RVUs as 90471, and each unit of 90461 has the same RVUs as

90472. Beats getting one administration fee that was valued the same as 90471!

AAFP Coding Resources web pages have been updated to provide more information on

these new codes and the guidelines for reporting them.

More to come on CPT code changes for 2011 in your January/February issue of

Family Practice Management !

==========================================

Some of the explanations are kind of confusing - single shot (but multiple

diseases) get multiple codes, etc.

Check out coding for Pentacel below.

====================================

http://illinoisaap.org/2010/10/new-cpt-codes-for-immunization-administration/

ICAAP > New CPT Codes for Immuniâ€¦ New CPT Codes for Immunization

Administration

Posted on: October 14, 2010

Tags: CPT , Immunization Administration , Vaccine Coding

Categorized: Â Feature Articles , ICAAP , Immunization Initiatives Reaching Our

Goals: Immunization Initiatives

New CPT Codes for Immunization Administration Effective January 1, 2011

The American Academy of Pediatrics (AAP) leadership met recently with executive

staff of Americaâ€™s Health Insurance Plans (AHIP) and informed them that the

AAP will be notifying carriers of the new codes and the need for timely adoption

by carrier claims systems.

The letter includes a vignette on howÂ the codes will be reported and urges

timely adoption of the new codes as well asÂ carrier claims systems to

processÂ multiple reporting of the codes to address concerns regardingÂ any

claim editsÂ that may limit the number of times a code can be reported. The

letter, as well as any carrier responses, will be posted on the AAP Member

Center . The letter will also be sent to AAP Chapters and pediatric councils to

share with their regional payers. AAP Coding Webinar Series (11.18.2010)

The AAP, as part of its coding webinar series, is conducting a webinar

onÂ November 18 th at noon (Central Time). This one-hour webinar will focus on

all CPT and ICD-9-CM changes for the upcoming year, but will focus primarily on

the new IA codes.Â Information on the webinar can be obtained at: Coding

Webinar Registration

Summary of the New Immunization Administration Codes

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires

covered entities utilize the code set that is valid at the time the service is

provided. This means that starting on January 1, 2011 codes 90460 and 90461 must

replace codes 90465-90468 in payer claims adjudication systems. AAP FAQ Fact

Sheet for 2011 Pediatric Immunization Administration Codes

90460 :

Immunization administration through 18 years of age via any route of

administration, with counseling by physician or other qualified health care

professional; first vaccine/toxoid component

90461 :

Immunization administration through 18 years of age via any route of

administration, with counseling by physician or other qualified health care

professional; each additional vaccine/toxoid component (list separately in

addition to code for primary procedure)

90471-90474:

These Immunization administration codes will remain unchanged and will continue

to be reported for patients 19 years and older, or if there is no counseling

performed on the patient or the healthcare professional counseling does not meet

state requirements for an â€œother qualified healthcare professional.â€

90465-90468:

The two new codes (90460, 90461) replace codes (90465, 90468)Â and are reported

based on the number of vaccine components rather than the number of

injections/administrations. When reporting the new codes, it is important to

understand how CPT defines a vaccine component: A component refers to all

antigens in a vaccine that prevent disease(s) caused by one organism.

Combination vaccines are those vaccines that contain multiple vaccine

components.

Following is comparison of the new codes (90460 and 90461) and the codes that

they will be replacing (90465-90468):

New CPT Codes:

90460 and 90461 CPT Codes Being Replaced:

90465-90468

Reported â€œperâ€ Vaccine component Immunization (single or combination)

Age restriction 18 years and younger Younger than 8 years of age

Counseling Required by physician or other qualified health care professional*

Required by physician

Routes of administration All routes of administration Codes differ based on

route of administration (eg, injectable vs. intranasal)

*CPT does not define â€œother qualified health care professional.â€ Refer to

state scope of practice laws to determine qualification. Vignettes for Code

Reporting

Vignette #1

Two-month old well child care visit, where the following vaccines are

administered after the patient/family has been counseled on each one: Vaccine

Vaccine Product CPT Code IA Code(s)

1. DTaP-Hib-IPV (PentacelÂ®) vaccine 90698 90460 [for the first vaccine

component (ie, diphtheria)]90461 [for the second vaccine component (ie,

tetanus)]

90461 (for the third vaccine component (ie, pertussis)]

90461 (for the fourth vaccine component (ie, Hib)]

90461 (for the fifth vaccine component (ie, IPV)]

2. Hepatitis B vaccine 90744 90460 [for the first (and only) vaccine

component]

3. Rotavirus (RotateqÂ®) vaccine 90680 90460 (for the first (and only) vaccine

component]

4. Pneumococcal (Prevnar-13Â®) vaccine 90670 90460 (for the first (and only)

vaccine component]

Vignette #2

Two-month old well child care visit, where the following vaccines are

administered after the patient/family has been counseled on each one: Vaccine

Vaccine Product CPT Code IA Code(s)

1. DTaP vaccine 90700 90460 [for the first vaccine component (ie,

diphtheria)]90461 [for the second vaccine component (ie, tetanus)]

90461 (for the third vaccine component (ie, pertussis)]

2. IPV vaccine 90713 90460 [for the first (and only) vaccine component]

3. Hib Vaccine 90645 90460 (for the first (and only) vaccine component]

4. Hepatitis B Vaccine 90744 90460 (for the first (and only) vaccine

component] 5. Rotavirus (RotateqÂ®) vaccine

6. Pneumococcal (Prevnar-13Â®) vaccine 90680

90670 90460 (for the first (and only) vaccine component]

90460 (for the first (and only) vaccine component]

* It is expected that relative value units (RVUs) will be published for the new

codes on the 2011 Medicare Resource-Based Relative Value Scale (RBRVS) in early

November 2010.

AAP is developing information on the immunization administration codes and

placing it on the AAP Practice Management Online (PMO).

For more information visit the AAP Practice Management Website.

Locke, MD

January 28, 2011