Forum - Questions & Answers

Apr 10th, 2015 - cmgmr 4 

Billing vaccine/immunization administration codes with an office visit

We have questions regarding billing vaccine/immunization admin codes. Our billing people seem to be on 2 different pages as far as this is concerned. One comes from a Pediatric billing background, the other comes from a Primary Care billing background. Any input will be greatly appreciated!

Can you bill for the vaccine/immunization administration when the patient is seen for an office visit? Our Pediatric person says yes you can bill the admin code and our Primary Care person says no you cannot.

Apr 10th, 2015 - ladyt 10 

re: Billing vaccine/immunization administration codes with an office visit

Yes you can bill for the administration of vaccine/immun. You want to append modifier 25 to the E/M code. The person who worked the PCP side left alot of money on the table in the past. Therapeutic drug injection rules are different
Good luck

Apr 10th, 2015 - petunia 195 

re: Billing vaccine/immunization administration codes with an office visit

Yes. You can bill for vaccine/immuniation administration when the patient is seen for an office visit. Our facility does all the time without problem and when I took the CPMA exam we were instructed to bill as well.

Apr 10th, 2015 -

re: Billing vaccine/immunization administration codes with an office visit

I copiend and pasted this article from the author of this site, if you put the question in the "look it up" you will most likely find your answer:

There are two sets of immunization administration codes to be used in addition to the vaccines themselves when. These are divided by the method of administration (IM, nasal, etc) and by the number of immunizations. The are also defined by whether vaccination counseling was provided to a child under the age of 8.

They are in the code range of 90465--90474.

Here is what the CPT® Assistant says:

Before CPT® 2005, codes for immunization administration (90471-90474) were too broad to allow an appropriate valuation of physician work. Because the pediatric population differs from adults, the model of vaccine delivery also differs in that physicians typically provide the necessary counseling about vaccines when informed consent is obtained prior to the actual administration.

with that being said there needs to be a different DX as to why the provider is billing for a seperate E&M service. If the patient came in jst for vaccines,you should only be billing for the administration of the vaccine and the vaccine code itself. Read the guidlelines in the CPT® book that address this issue. All vaccinse needs to be billed with the correct vaccine code as noted above!!!



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