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90460 & 90461
Dec
29
Hello everyone, I just received "Keep Up to Date on Primary Care Coding
and Reimbursement" and there is an article in there about codes 90460 &
90461. It basically states the following:
"Introductory remards to the vaccine administration section now state
conjugates and adjuvants shouldn't be considered a component of a vaccine
when reporting codes 90460 and 90461. Also, the descriptor for code 90460
has been revised to clarify that the code can only be reported once per
day of service. For example,k if a patient needed to be inoculasted
against three different diseases on the same day of service you would bill
one unit of 90460 and two units of 90461."
This confuses me, am I crazy or did they just take the new codes they
create last year and switch them basically back to to the codes we were
using back in 2010. I apoligize I don't remember those codes off hand, I
think they were 90465 & 66. So if I am reading this correctly, for a
typical 2MO visit with 4 vaccines (Pediarix, HIB, Prevnar and Rotateq) we
can now only bill the vaccine counseling as 90460 - 1 unit and 90461 3
units. Are we still allowed to bill 90461 for the extra antigens in the
Pediarix?
Any clarification on this would be great.
Thanks
Donna Ruge
Office Manager
Mary E. Lewis, MD, PC
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90460 & 90461
> Hello everyone, I just received "Keep Up to Date on Primary Care
> Coding
> and Reimbursement"
Can you tell us more about who produces this? I have seen and heard NOTHING which would support these comments:
> conjugates and adjuvants shouldn't be considered a component of a
> vaccine
> when reporting codes 90460 and 90461. Also, the descriptor for code
> 90460
> has been revised to clarify that the code can only be reported once
> per
> day of service.
That seems...crazy. Although anything is possible, I suspect this information.
--
Chip Hart - PCC
Director of Pediatric Solutions
800-722-7708
90460 & 90461
The name of the subscription article mag. is
Keep Up to Date of Primary Care Coding and Reimbursement. Its their
January 2012 issue Vol. 9 NO. 102. Published by Progressive Business
Publications. Editor Maggie Dewitt for Subcription information call
800-220-5000
If you need any further information about them just let me know.
Thanks
Donna
> From: "Donna Ruge"
>
>> Hello everyone, I just received "Keep Up to Date on Primary Care
>> Coding
>> and Reimbursement"
>
> Can you tell us more about who produces this? I have seen and heard
> NOTHING which would support these comments:
>
>> conjugates and adjuvants shouldn't be considered a component of a
>> vaccine
>> when reporting codes 90460 and 90461. Also, the descriptor for code
>> 90460
>> has been revised to clarify that the code can only be reported once
>> per
>> day of service.
>
> That seems...crazy. Although anything is possible, I suspect this
> information.
>
>
> --
> Chip Hart - PCC
> Director of Pediatric Solutions
> 800-722-7708
>
90460 & 90461
On 12/29/2011 02:37 PM, Donna Ruge wrote:
> Keep Up to Date of Primary Care Coding and Reimbursement. Its their
> January 2012 issue Vol. 9 NO. 102. Published by Progressive Business
> Publications. Editor Maggie Dewitt for Subcription information call
> 800-220-5000
Thanks, I'll look into it. I realized one thing:
>>> conjugates and adjuvants shouldn't be considered a component of a
>>> vaccine
>>> when reporting codes 90460 and 90461.
This has always been true - otherwise, a PCV-13 would have 12 90461s!
This is the issue that concerns me:
>>> Also, the descriptor for code
>>> 90460
>>> has been revised to clarify that the code can only be reported once
>>> per
>>> day of service.
--
Chip Hart - Pediatric Solutions * Physician's Computer Company
chip @ pcc.com * 1 Main St. #7, Winooski, VT 05404
800-722-7708 * http://pedsource.com/chipsblog
90460 & 90461
That is true, however, the Pediatrix is a Dtap, IPV and HEP B and I was
always assuming the Dtap was 3 antigens. However, I did just get around
to reading my Pediatric Coding Alert and it does state in there that the
tetnus in the Dtap is considered a adjuvant not an antigen and therefor
will not be subject to the vaccines counseling codes Dtap should be one
unit of 90460 + 1 unit of 90461
So it would be great if you could help clarify all of this.
Thanks
Donna
> On 12/29/2011 02:37 PM, Donna Ruge wrote:
>> Keep Up to Date of Primary Care Coding and Reimbursement. Its their
>> January 2012 issue Vol. 9 NO. 102. Published by Progressive Business
>> Publications. Editor Maggie Dewitt for Subcription information call
>> 800-220-5000
>
> Thanks, I'll look into it. I realized one thing:
>
>>>> conjugates and adjuvants shouldn't be considered a component of a
>>>> vaccine
>>>> when reporting codes 90460 and 90461.
>
> This has always been true - otherwise, a PCV-13 would have 12 90461s!
> This is the issue that concerns me:
>
>>>> Also, the descriptor for code
>>>> 90460
>>>> has been revised to clarify that the code can only be reported once
>>>> per
>>>> day of service.
>
> --
> Chip Hart - Pediatric Solutions * Physician's Computer Company
> chip @ pcc.com * 1 Main St. #7, Winooski, VT 05404
> 800-722-7708 * http://pedsource.com/chipsblog
>
90460 & 90461
On 12/29/2011 02:57 PM, Donna Ruge wrote:
> That is true, however, the Pediatrix is a Dtap, IPV and HEP B and I was
> always assuming the Dtap was 3 antigens. However, I did just get around
> to reading my Pediatric Coding Alert and it does state in there that the
> tetnus in the Dtap is considered a adjuvant not an antigen and therefor
> will not be subject to the vaccines counseling codes Dtap should be one
> unit of 90460 + 1 unit of 90461
Can you cite this for me? What issue? Can you quote it? Or fax it
to me? I'm certain that's wrong.
--
Chip Hart - Pediatric Solutions * Physician's Computer Company
chip @ pcc.com * Confessions of a Pediatric
800-722-7708 * Practice Management Consultant
* http://pedsource.com/chipsblog
90460 & 90461
Pediarix has 5 antigens. The T is not an adjuvant - it's a necessary antigen in the vaccine to prevent tetanus. It should be coded as 90460 plus 90461x4. Also, note that the proper notation is DTaP, not Dtap. The distinction is important.
Dave Hoffman
Camby, IN
----- Original Message -----
From: "Chip Hart"
To: "Donna Ruge"
Cc: "Pediatric Talk Group"
Sent: Tuesday, January 3, 2012 1:47:53 PM
Subject: Re: [PedTalk] 90460 & 90461
On 12/29/2011 02:57 PM, Donna Ruge wrote:
> That is true, however, the Pediatrix is a Dtap, IPV and HEP B and I was
> always assuming the Dtap was 3 antigens. However, I did just get around
> to reading my Pediatric Coding Alert and it does state in there that the
> tetnus in the Dtap is considered a adjuvant not an antigen and therefor
> will not be subject to the vaccines counseling codes Dtap should be one
> unit of 90460 + 1 unit of 90461
Can you cite this for me? What issue? Can you quote it? Or fax it
to me? I'm certain that's wrong.
--
Chip Hart - Pediatric Solutions * Physician's Computer Company
chip @ pcc.com * Confessions of a Pediatric
800-722-7708 * Practice Management Consultant
* http://pedsource.com/chipsblog
90460 & 90461
OK, two important updates!
1) After speaking to the coding wizards at the AAP, I think the "tetanus is
only a conjugate" issue is a bit of a mistake. It's ONLY for the 90644 CPT
code (the Hib-MenCY) which I bet none of you actually give. A DTaP is,
indeed, 3 pieces. A Pentacel remains 5.
http://practice.aap.org/content.aspx?aid=2980
2) However, this was a DOOZY from the AAP:
"There was an error printed in the CPT Changes 2012 book and the AMA will be
printing an errata forthcoming. That is not correct and CPT code 90460 and/or
90461 may be reported multiple times per day as appropriate.
Please do refer anyone questioning this to the 2012 CPT manual under the codes
where it states "Use 90460 for each vaccine administered." "
In other words, you CAN AND SHOULD report multiple 90460s, per day, as
appropriate.
--
Chip Hart - Pediatric Solutions * Physician's Computer Company
chip @ pcc.com * Confessions of a Pediatric
800-722-7708 * Practice Management Consultant
* http://pedsource.com/chipsblog