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Gardasil J code

Lynn Posted Fri 16th of December, 2011 01:44:36 AM

This is concerning an office visit for someting else, but HPV vaccine 2nd dose was administered at same visit. I have 90649 for HPV vaccination and 90471 for injection. I can not find the HCPCS code for the drug? Does anyone know the J code for Gardasil? I think other codes are right but please let me know if I am doing this wrong. These are for year 2010 codes. Thanks, Lynn

SuperCoder Answered Fri 16th of December, 2011 07:48:08 AM

CPT codes are right for vaccination and injection. But there is no Gardasil J code till now. Here is the link for 2011&12 drug table for your reference.
https://www.cms.gov/HCPCSReleaseCodeSets/Downloads/DRUG2011.pdf
https://www.cms.gov/HCPCSReleaseCodeSets/Downloads/DRUG2012.pdf

Lynn Posted Fri 16th of December, 2011 18:57:11 PM

How was Gardisal drug coded for year 2010 then? Thanks, Lynn

SuperCoder Answered Sat 17th of December, 2011 17:58:20 PM

Gardasil is a vaccine and you use the CPT for the one you injected (quadrivalent or bivalent). There was no J code for Gardasil. Only they were coded CPTs. Therefore you have to use 90649 (Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use) and then you should use the injection code 90471, which you have said earlier. Modifier -51 should not be reported for the vaccines, toxoids when performed with these administration procedures.

Lynn Posted Sat 17th of December, 2011 18:40:22 PM

In range specifics for V04.89 it says; If a specific vaccine code is not available, the unlisted procedure code should be reported, until a new code becomes available. What is the unlisted code they are talking about here? As this visit was for lump in breast and not an excounter for the vaccine I don't feel I can use V04.89. Is this so, in this circumstance? I used MODIFIER 25 to explain the injection of Gardisal. I need ONE more code besides 99214-25, 611.72, 90649, 90471. So what is the unlisted code they are talking about here or should I use V04.89. Thanks for any help you can give! Lynn

SuperCoder Answered Sat 17th of December, 2011 19:25:35 PM

You can't use V04.89 for lump in breast visit. I am not getting where it has mentioned for unlisted Px. Could you please let me know where exactly it has mentioned??

There is only one standard way to bill for the HPV vaccine. The codes for the vaccine are: 90649 (quadrivalent - Gardasil), or 90650 (bivalent - Cervarix) and then you bill for the injection of the vaccine with 90471. The Dx is V04.89. An unspecified code is not appropriate because the vaccines have a specific code.

Lynn Posted Sun 18th of December, 2011 09:28:04 AM

I'm as puzzeled as you now as I can't find again where I copied and pasted this sentence; If a specific vaccine code is not available, the unlisted procedure code should be reported, until a new code becomes available. But it was here on supercoder. I will use V04.89 instead of a J code for the drug Gardasil and see what happens.

Lynn Posted Mon 19th of December, 2011 21:17:46 PM

I haven't submitted this yet as I wonder if this was meant? A NOS of immunosuppressive drug 'J7599'??? Would you code this or V04.89 (for other viral disease)? I need one more code wether it is a Dx or drug code I don't know. I do know I don't need another Px code.

SuperCoder Answered Tue 20th of December, 2011 07:32:42 AM

As per my knowledge goes, there is no HCPCS J code for Human Papillomavirus Quadrivalent. As per my knowledge goes, you can't code J7599 immunosuppressive drug for vaccine, only you have to use CPT 90649 and as per, injection code should be reported. As you did not need any Px code, you could use V04.89 Dx (other viral disease).

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