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Vaccine Coding

  • 1.  Vaccine Coding

    Posted 10-17-2017 20:14
    I recall getting reminded about the 90460 and 90461 codes for pediatric vaccines and I just did a Tdap and tried to bill 90460 (X1 ) and 90461 X2.  The insurance rejected the 90461 saying it wasn't "attached" to any vaccine.   I read the blurb in the AAFP journal about how to code for this, each antigen in a vaccine gets a separate administration code.

    Did you get any kick-back from insurance companies and have to explain that each antigen is counted separately?   (Kick-back is a poor choice of words but the only word I can think of)

    Is everyone getting paid for this?

    Kathleen Saradarian, MD
    Branchville, NJ

  • 2.  RE: Vaccine Coding

    Posted 10-18-2017 06:37

    I'm not sure how to 'attach' since we are just using Z23 for all vaccines now with ICD10.  I am getting paid for both.  Did you do another vaccine on the same claim?  If not, one would think the TDaP would be the only possibility for both the 90460 and 90461.


  • 3.  RE: Vaccine Coding

    Posted 10-18-2017 11:14
    Since we started doing this we get paid without push back and much more than when we didn't do separate Ag. Well worth it.

    Since ICD-10 it's easier as all codes for all vaccines now the same- z23 I think.
    Was it maybe something with the ICD10 coding, i.e. you used something other than z23?

    Why oh why can't they just say?

    What a silly game we are forced to play. I feel like my employed friends sometimes seem to forgot that everyone, all institutional medicine, is forced to play too. That just cause you aren't looking at it when you do your medicine, doesn't make it an ok system and that this game consumes tons of institutional healthcare dollars. Maybe it just feels too big and unwieldy. And billing staff, given that's their job, aren't going to speak up about how crazy it is.

    I'm glad that we in IMPs, given we're trained as critically thinking docs, see and verbalized and speak up against the absurdity as we do have to deal with it daily. I personally write complaints to the WA insurance commissioner. Figure it only takes my time and when they get enough, at some point change will happen.

    Ok- I fell into a rant...

    Melissa Weakland, MD
    Ballard Neighborhood Doctors
    5416 Barnes Ave NW
    Seattle, WA 98107
    Phone: (206)-297-7678
    Fax: (206)-297-5930

  • 4.  RE: Vaccine Coding

    Posted 10-23-2017 09:57
    Is anyone successfully billing 90471 / 72 for adults when they bill for a tetanus booster?
    90460 / 61 are for patients under 18.

    I realize Medicare will only pay for tetanus vaccination if coded with an injury / laceration / foreign body, etc.

    Michael S. MD

  • 5.  RE: Vaccine Coding

    Posted 10-23-2017 17:04
    Yes, you should be able to put modifier -25 on your visit and get paid for the 90715 TdaP (or the Td code) and get the 90471 and 90472 paid. Same on all other vaccines.

    UHC and Tricare want the NDC # and units.

    Medicare and Medicare Advantage will need to see G0008 and G0009 instead of 90471 and 90472 when billing for flu shot and pneumococcal.

    Mamatha Agrawal, MD
    Family Doctor CaryNC
    Cary, NC
    Live in Raleigh, NC
    Solo since 2012
    Practice Fusion and NueMD

  • 6.  RE: Vaccine Coding

    Posted 10-24-2017 17:52
    Yes.  All the time.  (As long as not Medicare).

    Kathy Saradarian, MD

    Quality Family Practice

    Branchville, NJ 07826

  • 7.  RE: Vaccine Coding

    Posted 10-25-2017 05:52
    Kathy and Mamatha,

    Thank you for responses.

    Just to be clear.....for adults you are billing 90471 and 90472, with routine Td and Tdap, and being reimbursed for both administration codes by some  HMOs, PPOs, blues, etc.?

    For adults are you using V03.7?   I believe z23 is for children less than 7.

    I realize with Medicare, these codes are not reimbursed by Part B in the office unless they are associated with an acute laceration, etc.

    Thanks again.

    Michael S. MD

  • 8.  RE: Vaccine Coding

    Posted 10-26-2017 14:31
    For a Td or Tdap I bill the appropriate CPT code for the vaccine and a 90471 if it's the only vaccine given or a 90472?? if another vaccine?? is given.?? The DX code for all vaccines is Z23.?? (The V codes are ICD9 and are gone).?? I get paid for the vaccine and an administration code by everyone but Certain Medicaid patients that are covered by VFC and therefore you can't get reimbursed for the vaccine but you should be able to get covered for the administration.

    Who isn't paying you?
    --  Kathy Saradarian, MD Solo since 2003 Always Private, Small Group since 1990 Practice Partner since 2003 Branchville, NJ