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At Hope Practice Management and Associates we are committed to the highest medical billing and consulting standards, offering many different services and products. Each client is unique within their own specialty, so we provide cost effective solutions that will directly accommodate their own personal needs. We have a proven record of improving cash flow, reducing problem A/R, dramatically improving claims submission turn-around time, implementing reimbursement solutions, and auditing for correct coding.



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ARE YOU CORRECTLY CODING IMMUNIZATION ADMINISTRATIONS?

CPT 2011 brought about big changes for immunization administration for patients 18 years and younger. Codes 90465, 90466, 90467, and 90468 have been deleted. They have been replaced by two new codes:
  • 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)
There is a change worth noting with these two new codes. The previous administration codes specified in their description that the counseling provided was done by the "physician". The two new codes state the counseling is provided by "physician or other qualified health care professional". This means mid-level providers would be able to bill and be reimbursed for the administration of immunization if the counseling is documented properly in the medical record. Be aware that if an immunization is administered to a patient who is 18 years or younger and counseling is not provided, the CPT code to use for the administration is:
  • 90471 - Immunization administration (includes percutaneous, intradermal, Subcutaneous, or intramuscular injections); 1 vaccine (single or Combination vaccine/toxoid)
  • 90472 - each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure)
An example of this would be a 12 year old patient who comes in for their second HPV immunization. Assuming the patient would have received counseling during their visit for the first HPV immunization, and no further counseling is provided for the second administration, it would be billed with CPT code 90471. To further complicate the scenario, if the same patient received another immunization (ie tetanus) during the same visit as the second HPV vaccine, and received counseling for it, you would code the administration of the tetanus as 90460.

Announcements

  • Join us at the The National Indian Health Board (NIHB) for the National Tribal Health Conference on September 25 – 28, 2017 in Bellevue, WA at the Hyatt Regency. If you'd like to see how HPMA can help you through the maze of ever changing Federal and State rules for medical management and how it can affect your clinic, please stop at see us at our booth.

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