You-ve already got a code for the vaccine, thanks to CPT 2006. -You may have noticed the lightning bolt in front of 90649 (Human papillomavirus [HPV] vaccine, types 6, 11, 16, 18 [quadrivalent], 3-dose schedule, for intramuscular use). That symbol means you cannot use this code until the Food and Drug Administration gives its approval,- says Melanie Witt, RN, CPC-OGS, MA, an ob-gyn coding expert based in Guadalupita, N.M. -The good news is that on June 8, the FDA officially licensed the vaccine for use in girls and women ages 9 to 26.- Get a Clear Picture of Your Vaccine Claim When your ob-gyn administers the HPV vaccine, you should use 90649, which covers types 6, 11, 16 and 18 on a three-dose schedule. You should report 90649 three times during a six-month period.
Your diagnosis should be V04.89 (Need for prophylactic vaccination and inoculation against certain viral diseases; other viral diseases), says Patricia Larabee, CPC, CCP, an ob-gyn coding specialist at InterMed in South Portland, Maine.
You should also report 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]) for the vaccine administration.
Your diagnosis will be V04.89 for this code as well. Get the Modifier Low-Down The good news is that CPT guidelines state you should not append modifier 51 (Multiple procedures) to either 90649 or 90471.
Also, if your ob-gyn provides a significant and separate E/M service during the same visit that she administers the vaccine, you may also bill an E/M code with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) appended to inform the payer that the E/M service was separate.
Keep in mind: Almost all payers will not pay separately for 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician. Usually, the presenting problem[s] are minimal -) plus an injection procedure because this E/M code represents a minimal, not significant, E/M service, Witt says.
Cover Your Bases With Payers Until the Centers for Disease Control comes out with [...]