Home Forums Discussions Coding and Billing Billing for vaccinations

I have a question on billing for vaccinations. I am confused on the codes 90471 and 90472.

Lets say we give someone a Influenza, Pneumonia, and T-Dap vaccines. How would we bill it?

Would i bill 3 90471's (one for each separate vaccine) or 90471 for the first one and 90472 for the others.

Thanks!

Ben

I think it is 90471 for the first and 90472 for subsequent vaccines.

No that is the old way (with the now obsolete 90465/6)

It is per component of vaccine. Thus:

DTaP is 90471 x 1 and 90472 x 2 (tetanus and pertussis)
MMR is same (measles is 90471 then mumps and rubella are 90472)

This way there is no incentive to separate shots to maximize reimbursement.

It was my understanding that this coding of each "component" separately only applies to the pediatric population, and even then, depending on whether or not certain counseling was provided during the visit or not. For the adult population, I believe it's still 90470 reported once for the initial injection, and 90471 reported as many times as there are additional "shots" (not "components").

If < 18, with counseling:
90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component,
90461 Each additional vaccine/toxoid component. (List separately in addition to code for primary procedure.)

If >=18yo, or < 18 but given without counseling:
90471 ? Immunization administration (including percutaneous, subcutaneous, intramuscular, or jet injections); one vaccine (single or combination vaccine/toxoid)
90472 - each additional vaccine (single or combination vaccine/toxoid)
90473 ? Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)
90474 - each additional vaccine (single or combination vaccine/toxoid)

Sources:
http://bit.ly/u5mRMf
http://bit.ly/gje50x