Home Forums Discussions General Discussion Pediatrics /new codes 90460,90461 and rejection

I have started using the new codes for vaccines , but when i generate the AC 1500 instead of writing separate 90460 and 90461 after each vaccine ( as wanted by most insurance ) when i add new vaacine code, after that when i add 90460 or 90461 , it just adds the ones on top and increases their number and the insurances are rejecting it , any solutions , when I called AC tech support guy no helpful, said he asked everyone , suggested I make separate 1500 for each shot or better use EZ claims ??? any solutions( for now i am just printing the 1500 off AC and submitting paper claims, I am in texas.

I think you will need to submit this as a serious bug report.

I had to re-read this to understand, but it is NOT a bug as I understand it.

If he does 3 vaccines it should give 90460 x 1(first immunization) and 90461 x 2(subsequent immunizations). This is the way all other things in medicine are billed. Code x number of times used.

I outsource my billing but it is electronically generated in AC. I have seen this is how the bills are being generated. To my knowledge they are all being paid. What insurance company is requiring it this other way?

I would talk to the insurance company, because most billing is done this way.

Maybe i misunderstood what he was describing.

sorry did not visit the site , i called the AC team many times and they say they dont have a cure for this thing yet , for now i have to spend extra amount of time , modifying my 1500 manually
eg electronically when the encounter is generted for three vaccines in AC ( lets say for Dtap, varicella , MMR)
its
90700
90460 units 3
90461 units 4
90716
90707
but what the texas mediaid wants is sequential
90700
90460 unit 1
90461 unit 2
90716
90460 unit 1
90707
90460 unit 1
90461 unit 2
hope u can understand what i am trying to say

90460 should only be used once. all other immunizations will be 90461.
I do understand that they want individual 90461's with each immunization.

My only advice is to call them and ask them to move to the 21st century. You can threaten to paper send them and it is more expensive on their end (especially if it is hand written paper which will take more to convert.)

In Illinois, Medicaid does not use a standard HCFA 1500 they use a special 1500 (which of course is different and is not compatable, they are available free, however.) It is their way of making billing more difficult. You would think they would try to make it easy on providers who are willing to work for minimum wage.

Most billing programs I have seen group codes.

My SANOFI-PASTEUR vaccine rep instructed me that for each vaccine, the first component is 90460 and remaining components are 90461. Indeed the 90460 is repeated with each separate vaccine. Thanks for the heads up with billing. I have no idea if the billers are even handling this correctly despite my detailed instructions. It is a waste-of-time rule. I think they keep changing codes just to avoid payment.

I have a handout from one of my insurers that says the following as an example:
MMR 90460
DTaP
Pneumo 90461 x 2

another visit...
RV 90460
DTAP-Hib-IPV 90461 x 1

It looks like they only want to pay for 1 unit of 90461 with each additional SHOT, but I thought it was originally for each add component.

This is a great example of why a coding and billing section would be great on here.

I am still using the 90471 and the 90472 codes and insurances are still paying. Did they say when they will start denying these codes?

IF YOU READ THIS EARLIER, IT HAS CHANGED
I just received this from the Illinois Chapter of the AAP

"The American Academy of Pediatrics (AAP) has been in contact with Blue Cross Blue Shield (BCBS) of Illinois on its claims processing for immunization administration. To facilitate payment and reduce claim denials as duplicates, when submitting claims to BCBS of IL for immunization administration using codes 90460 (immunization administration, first component) and 90461 (each additional component) for multiple vaccines and/or multiple components, you must report the code(s) in units and not per line item. By submitting per line item, claims are unable to be adjudicated appropriately. For example, if you administer a Pentacel (DTaP-Hib-IPV), Hepatitis B and a Pneumococcal, you should report 90460 with 3 units and 90461 with 4 units in addition to the appropriate vaccine product codes."

THUS They should be combined but not in the way I stated above. I just learned something.