Re: Re: 2011 Pediatric Immunization Administration Codes - updated - confusing

[Guest guest]

Did anything new ever come of these new coding?Anyone getting paid by coding out as recommend by the AAP?AAP tried to explain it...  http://practice.aap.org/content.aspx?aid=2980

Here is an example...

A patient presents for her 2-month well-child check and is given the DTaP-Hib-IPV (Pentacel), pneumococcal, and rotavirus vaccines.

 

CPT Descriptor CPT code Units

Line 1Preventive medicine service <1 year

99391 1

Line 2DTaP-Hib-IPV (Pentacel) vaccine

90698 1

Line 3First (Pentacel) vaccine component

90460 1

Line 4Each additional (Pentacel) component

90461 4

Line 5Pneumococcal vaccine

90670 1

Line 6First (pneumococcal) vaccine component

90460 1

Line 7Rotavirus vaccine

90680 1

Line 8First (rotavirus) component

90460 1

So you code a 90460, but attach the ICD9 for the Pentacel and Pneumococcal and Rotavirus - and charge for 3 units?Instead of the old style of charging once for the 1st Admin, and then charging for a f/u Admin for however many other shots were given.

And then code a 90461 with the ICD9 for the Pentacel, but put 4 units (for the additional 4 components of the Pentacel).

And if we gave 2 different multi component shots (ie Pentacel and MMR) at the same visit (for a kid that is behind in shots, let's say), then we do the 90461 and attach the ICD9 for Pentacel and MMR, but add 4 units for the Pentacel and 2 units for the MMR giving 6 units of 90461 (plus 90460 for the 1st unit of the Pentacel and MMR for a total of 2 units)?

Sigh...I think I get it, but not sure why I can charge for the extra components separately when they are given together in the same shot.Plus -- worry that insurances aren't hep to the coding yet and it will be a big mess.

Anyone getting paid using this coding method? Locke, MD

[Guest guest]

We are getting paid by most insurance companies for the new codes. Since I do a lot of peds it is really making a difference

Larry Lindeman MDRoscoe Village Family Medicine2255 W. RoscoeChicago, Illinois 60618www.roscoevillagefamilymedicine.com

Did anything new ever come of these new coding?Anyone getting paid by coding out as recommend by the AAP?AAP tried to explain it... http://practice.aap.org/content.aspx?aid=2980

Here is an example...

A patient presents for her 2-month well-child check and is given the DTaP-Hib-IPV (Pentacel), pneumococcal, and rotavirus vaccines.

CPT Descriptor CPT code Units

Line 1Preventive medicine service <1 year

99391 1

Line 2DTaP-Hib-IPV (Pentacel) vaccine

90698 1

Line 3First (Pentacel) vaccine component

90460 1

Line 4Each additional (Pentacel) component

90461 4

Line 5Pneumococcal vaccine

90670 1

Line 6First (pneumococcal) vaccine component

90460 1

Line 7Rotavirus vaccine

90680 1

Line 8First (rotavirus) component

90460 1

So you code a 90460, but attach the ICD9 for the Pentacel and Pneumococcal and Rotavirus - and charge for 3 units?Instead of the old style of charging once for the 1st Admin, and then charging for a f/u Admin for however many other shots were given.

And then code a 90461 with the ICD9 for the Pentacel, but put 4 units (for the additional 4 components of the Pentacel).

And if we gave 2 different multi component shots (ie Pentacel and MMR) at the same visit (for a kid that is behind in shots, let's say), then we do the 90461 and attach the ICD9 for Pentacel and MMR, but add 4 units for the Pentacel and 2 units for the MMR giving 6 units of 90461 (plus 90460 for the 1st unit of the Pentacel and MMR for a total of 2 units)?

Sigh...I think I get it, but not sure why I can charge for the extra components separately when they are given together in the same shot.Plus -- worry that insurances aren't hep to the coding yet and it will be a big mess.

Anyone getting paid using this coding method? Locke, MD

[Guest guest]

getting paid but have to often fight about it.BCBS - in my area - list all 90460's together, each unit charge $30 and get paid about 27/ unitUnited - have to list each vaccine code eg 90715 for Tdap the list 90460 and then 90461 (x2) what a pain, when they deny them which is often then you have to call resubmit, submit claim correction call, complain, etc.sometimes eventually you get paidTo: ; practicemgt@...From: lockecolorado@...Date: Tue, 8 Nov 2011 00:13:11 -0700Subject: Re: Re: 2011 Pediatric Immunization Administration Codes - updated - confusing

Did anything new ever come of these new coding?Anyone getting paid by coding out as recommend by the AAP?AAP tried to explain it... http://practice.aap.org/content.aspx?aid=2980

Here is an example...

A patient presents for her 2-month well-child check and is given the DTaP-Hib-IPV (Pentacel), pneumococcal, and rotavirus vaccines.

CPT Descriptor CPT code Units

Line 1Preventive medicine service <1 year

99391 1

Line 2DTaP-Hib-IPV (Pentacel) vaccine

90698 1

Line 3First (Pentacel) vaccine component

90460 1

Line 4Each additional (Pentacel) component

90461 4

Line 5Pneumococcal vaccine

90670 1

Line 6First (pneumococcal) vaccine component

90460 1

Line 7Rotavirus vaccine

90680 1

Line 8First (rotavirus) component

90460 1

So you code a 90460, but attach the ICD9 for the Pentacel and Pneumococcal and Rotavirus - and charge for 3 units?Instead of the old style of charging once for the 1st Admin, and then charging for a f/u Admin for however many other shots were given.

And then code a 90461 with the ICD9 for the Pentacel, but put 4 units (for the additional 4 components of the Pentacel).

And if we gave 2 different multi component shots (ie Pentacel and MMR) at the same visit (for a kid that is behind in shots, let's say), then we do the 90461 and attach the ICD9 for Pentacel and MMR, but add 4 units for the Pentacel and 2 units for the MMR giving 6 units of 90461 (plus 90460 for the 1st unit of the Pentacel and MMR for a total of 2 units)?

Sigh...I think I get it, but not sure why I can charge for the extra components separately when they are given together in the same shot.Plus -- worry that insurances aren't hep to the coding yet and it will be a big mess.

Anyone getting paid using this coding method? Locke, MD