Q&A: Coding for multiple immunizations

Q: The physicians in our family practice often administer more than one immunization on the same day. Can we bill more than one initial administration per visit?

The overarching rule of the immunization administration coding protocol is that you can report only one initial immunization code per visit. The "resources" expended, and therefore the relative value units assigned, are higher for the "first" administration code. If you report more than one "first," you would be double-dipping, the AAP says.

Similarly, for patients 8 years and older, you would correctly code 90471 for administration of the DTaP injectable and 90474 (twice) for administration of the intranasal flu and oral rotavirus vaccines.

The "each additional" administration codes seem to apply to the code immediately preceding them. Where this gets confusing, however, is when the second immunization is administered via a different method.

It is required for you to mix and match across the four different codes for each age range-pediatric injection, pediatric oral/intranasal, 8-and-over injection, and 8-and-over oral/intranasal. Though it doesn't sound right, keep in mind that you cannot bill two initial of anything on the same day.

Here's an example of correctly mixing and matching: A 7-year-old girl receives her second hepatitis B vaccine and the intranasal influenza vaccine in conjunction with her preventive visit. The physician provides the counseling associated with each vaccine. Proper codes would be 90465 for the hepatitis B immunization administration and 90744 for the intramuscular hepatitis B vaccine supply, and 90468 for the intranasal flu immunization and 90660 for the intranasal influenza virus vaccine supply.

You would also code separately for the preventive visit and any other applicable services.

The author is a compliance manager for Baptist Medical Associates in Louisville, Kentucky.