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question on cpt 90473 & 90474

Bonnie Answered Mon 14th of November, 2011 18:54:13 PM

Please verify for me in what instances we can use 90473 with regards to 90460, 90461, 90471 or 90472?

Example: We billed 90460 & 90461 with 90474 and UHC denied the 90474 reimbursement stating that we should billed the 90473.

And, they are also saying if we do not have 90471 or 90473 on the claim we cannot bill 90474, even when using 90460 or 90461 with an oral or nasal vaccine administration?

Could you please advise as to the correct way we should be billing
this admin fee.

SuperCoder Answered Tue 15th of November, 2011 02:44:00 AM

To patients 18 years of age or younger:-
You can bill 90461 if you bill it with 90460----because 90461 is an Add-on code for 90460
To patients over the age of 18:-
You can bill 90472 if you bill it with 90471----because 90472 is an Add-on code for 90471
You can bill 90474 if you bill it with 90473----because 90474 is an Add-on code for 90473
Note:
Either the patient is 18 years age or younger, OR the patient is over the age of 18
So, you can't code 90460&90461 with any code of 90471-90474

Bonnie Answered Tue 15th of November, 2011 14:07:49 PM

I need to know if you are billing 90460 & 90461 and you give a oral or nasal vaccine would you
then use 90473 for the first oral or nasal
vaccine

SuperCoder Answered Tue 15th of November, 2011 14:15:43 PM

Sorry! 90463 is an Invalid code.

Bonnie Answered Tue 15th of November, 2011 14:30:12 PM

I meant 90473

SuperCoder Answered Tue 15th of November, 2011 15:22:21 PM

You can not use 90473 when you are billing 90460 and 90461.
Reason:90473 is used for patient age over 18
90460 and 90461 is used for patient age of 18 years or younger.
*
How can a patient's age be considered both above age 18 & =or below age 18?

Bonnie Answered Tue 15th of November, 2011 15:49:33 PM

90473 & 90474 do not have an age limit according to the 2011 Cpt book.
We were told by UHC that as of 10-16-2011 we have to bill 90473 for
the first oral or nasal vaccine and 90474 can be used for the second
oral or nasal vaccine. when billed with 90460 & 90461.

Bonnie Answered Tue 15th of November, 2011 18:19:38 PM

Can anyone tell me how they are billing the admin fee for Flumist or Rotavirus
when other vaccines are given on the same day. We use 90473 & 90474. But
there is alot of confusion on how to use these admin fees.

SuperCoder Answered Wed 16th of November, 2011 15:26:10 PM

Please refer to this article of Amercian Academy of Pediatrics for age related info(Pg.No.2) for the above codes:
http://publichealth.lacounty.gov/ip/providers/AAP2011vaccinecodingchanges.pdf

Bonnie Answered Wed 16th of November, 2011 16:15:20 PM

Thank you for your help

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