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New Vaccine Administration Codes

Amanda Posted Fri 14th of January, 2011 22:14:27 PM

Our practice is not being reimbursed for the new vaccine administration codes 90460 and 90461. We are currently disputing this as a HIPPA violation; however, I also need the ruling that states that Medicaid companies are required to pay physicians for the administration of vaccines. Can anyone point me to a site that contains that ruling or information please? Thanks.

Super Answered Fri 14th of January, 2011 22:40:24 PM

Why HIPPA violation?

Patricia Answered Sat 15th of January, 2011 00:11:15 AM

I WAS JUST TOLD TODAY BY OUR MEDICAID REP IN LOUISIANA NOT TO USE THE 90460/61 CODES THAT SHE JUST RECEIVED AN EMAIL STATING THEY WILL NOT BE ADDING THESE CODES TO CONTINUE TO USE THE 9047* CODES. WHERE ARE YOU LOCATED?

HOPE THIS HELPS.
PATRICIA

SuperCoder Answered Sat 15th of January, 2011 05:13:28 AM

REIMBURSEMENT ISSUES ARE TO BE HANDLED TAKING INTO ACCOUNT MULTIPLE ISSUES, NOT JUST ON THE BASIS OF CODING GUIDELINES.
But first check if your coding is compliant to the coding guidelines as follows:
You will be able to use medicine series vaccine administration codes on older patients and even when a nurse provides the counseling.

Report 90460, +90461 through age 18

As counseling for adolescents can involve as much time as counseling on vaccines for younger children, the American Academy of Pediatrics recommended that the age limitation on the vaccine administration with counseling codes be raised. Just-in codes (90460, Immunization administration through 18 years of age via any route of administration, with counseling by doctor or other qualified health care professional; first vaccine/toxoid component and +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]) extend vaccine administration with counseling to patients through 18 years of age.

The new vaccine administration with counseling code extend the counseling opportunity to any qualified healthcare professional practicing within his/her state described scope of practice. An RN, LPN or medical technician could provide the counseling and the practice could still use the vaccine administration with counseling code.

These codes are limited to immunization administration, meaning purchased vaccine products must be separately reported.

When to code it differently:-
A face-to-face service where a physician or other qualified health care professional (qualified per state licensure) provides counseling to the patient and/or caregivers is required to report 90460-90461. In the absence of counseling, the administrations must be reported with codes 90471-90474.
Example:
If the vaccines are administered on a different day than the vaccine counseling because of patient’s illness, then codes 90460-90461 cannot be reported. In these situations, continue to report the immunization administration using codes 90471-90474, since they do not have explicit counseling requirements as part of their descriptors.

ICD guidelines involved:-

Per ICD-9-CM guidelines, code V20.2 encompasses all age appropriate vaccines administered during a routine health check to patients through 17 years of age and, therefore, should be the only diagnosis code reported for any vaccine administered during a routine well-baby/infant/check. For patients 18 years of age and above, report V70.0 instead of V20.2.

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