Vaccine Administration Codes they are a changin…

If you haven’t heard, effective January 1, 2011 there will be substantial changes to the pediatric vaccine administration codes. There is no “grace period” and folks who have not integrated these changes into their software by that date will be wishing they had a pediatric-specific EHR that cared as much as Office Practicum does!

In an effort to address the issue of combination vaccines, the American Academy of Pediatrics has worked to get two new codes recognized. These codes are based on the number of vaccine components (antigens) rather than the number of injections/administrations:

90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first vaccine/toxoid component.

+90461 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; each additional vaccine/toxoid component (list separately in addition to code for primary procedure)

In addition, codes 90465, 90466, 90467 and 90468 will be deleted from the CPT nomenclature.

Usage of the new codes differs from the old ones in three important ways:

1. They are valid for counseling through 18 years of age, rather than 8.

2. The counseling may be performed by any qualified healthcare professional, not just a physician or NP/PA. This includes nurses, but may not include MAs depending on how your state defines “qualified healthcare professionals.”

3. There is no distinction between IM vs. other routes of administration.

The RVUs for the new codes have not yet been assigned by CMS, but they are expected to be available in early November. It remains to be seen how this will translate to appropriate payment for pediatricians. For example, insurance companies are used to paying one vaccine administration code for Tdap. Beginning January 1,Tdap will have three attached administration codes: 90460 and then 90461 x 2. We anticipate that payers will likely not be excited by these changes, but let’s hope that pediatricians will finally be paid adequately for all this work!

Please note that the existing codes in the 9047x series for non-counseled vaccines will continue to exist, and all of the old rules (including the distinction between IM and other routes of administration) will still apply. These must be used over the age of 18, and they may be used (at the provider’s discretion) under the age of 18.

Stay tuned for more information as the AAP is working with payers and all stakeholders to try and make this go as smoothly as possible. The devil will be in the details but OP users should know that Connexin Software is monitoring this information as it is being released and is committed to having the logic programmed and delivered for your use prior to January 1! Yet another reason to have a Pediatric EHR!


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