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   RE: vaccine billing- maybe everyone else already knows..
 From: Jean Antonucci
 To: Member Forum
 Posted: 10-31-2016 06:51

wow   I find this to be a scam  PCPs use to survive   egads how broken this system is   I do not  even use the code with counselling- I rarely need to counsel   Do we actually counsel on the  D and the T and the P? I do not find this to be a solution to the  problem  IT raises the cost of care  Addtionally I doubt if the VFC program many of us use would allow Hmm we are told to use 90471 and get 28.56( whichis fine  ) The private spay 30+ for that code which is also fine  God things are broken 

Jean Antonucci
Original Message:
Sent: 10-31-2016 01:18
From: Melissa Weakland
Subject: vaccine billing- maybe everyone else already knows..

This came up in our recent regional meeting. thanks and thanks Amy.

Giving vaccines, per Amy, should help us make money.  We've always just done them to hopefully break even. And mostly because we feel we should.

I've never never coded correctly. Amy reminded us that  vaccine admin fee is charged for each component in a vaccine - and first component fee is used for ALL single vaccines.

Additional component fee is only for combination vaccines.  So a Tdap gets billed for 3 administration fees- the higher price for the first component and lower price for the second and third components.

This is a fairly large cost difference for us. 

I copied this from AAFP

"codes are reported per vaccine/toxoid component. CPT defines a component for these purposes as each antigen in a vaccine that prevents disease(s) caused by one organism. Combination vaccines are those vaccines that contain multiple vaccine components.

You may report multiple units of code 90460 for each first vaccine/toxoid component administered. No modifier should be required when reporting multiple first components. Note also that code 90460 does not apply only to combination vaccines, but also to single component vaccines (such as influenza, human papilloma virus, or pneumococcal conjugate vaccines). This base code is reported for each vaccine administration to patients 18 years of age and under who receive counseling about the vaccine from a physician or qualified health care professional at the time of administration. Code 90461 is an add-on code reported for each additional vaccine component administered.

Administration Coding Example

An 11-year old girl presents for a preventive visit (99393). In addition, the child and her mother are counseled by the physician on risks and benefits of HPV (90649), Tdap (90715) and seasonal influenza (90660) vaccines. The mother signs consent to administration of these vaccines. A nurse prepares and administers each vaccine, completes chart documentation and vaccine registry entries, and verifies there is no immediate adverse reaction.

CPT Codes reported are:
99393 - Preventive service
90649 - HPV vaccine
90460 - Administration first component (1 unit)
90715 - Tdap vaccine
90460 - Administration first component (1 unit)
90461 - 2 additional components (2 units)
90660 - Influenza vaccine, live, for intranasal use
90460 - Administration first component (1 unit)

Melissa Weakland MD
Ballard Neighborhood Doctors
Seattle WA
IMP since 2007

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