Vaccine Administration Changes are a Sticky Business for 2011

The vaccine administration codes are changing in CPT 2011 and the new series of codes is no longer assigned based on the number of “sticks” the patient receives. The existing codes, 90465-90468, have been replaced by codes 90460 and 90461, which now represent vaccine administration via any route and to a patient through age 18 years of age with counseling by a physician or other qualified health care professional. These codes are assigned based on the number of vaccines/toxoid components that are administered, not on the individual administrations, as was previously done.

A vaccine or toxoid component is an antigen in a vaccine that prevents a disease or diseases that are caused by one organism. For example, code 90700 is the vaccine for Diphtheria, tetanus toxoid, and acellular pertussis and contains those three vaccine/toxoid components. If this vaccine is administered to a patient under age 18 years and counseling is provided by the physician, three administration codes are required: 90460, 90461 and 90461. If multiple vaccines are administered according to the CDC immunization schedule, multiples of these codes are assigned. Here’s a more detailed example for the vaccines normally given at 6 months of age. This child might receive the following:

• Hepatitis B/Hib combination vaccine (90460 and 90461).
• Rotavirus vaccine (90460).
• DTaP vaccine (90460, 90461 and 90461).
• Pneumococcal conjugate vaccine (90460).
• Inactivated polio vaccine (90460).

To code the administration of these vaccines (following counseling by the physician), the coder should assign the codes in parentheses, which include 5 units of 90460 and 3 units of 90461. Coding for vaccines administered to patients over age 18 years or without the provision of counseling is still coded the same way for 2011, using codes 90471 through 90474.

Written by: Lynn Keuhn, MS, RHIA, CCS-P, FAHIMA