Abstract: While the Current Procedural Terminology (CPT
®) Preventive Medicine Services (PMS) codes (99381-99397) include work related to the review of the vaccine history, all other components of vaccine counseling are included in the Immunization Administration codes (90460-90474).
There is an incorrect belief that the Medicare Resource-Based Relative Value Scale (RBRVS) relative values assigned to the Preventive Medicine Services (PMS) codes (99381-99397) include all or most of the resources (ie, physician work, practice expense, and professional liability insurance expense) expended in the service of vaccine counseling. While vaccines are typically administered during the course of a PMS visit and remain the most evidence-informed component of such visits, immunization administration can also occur during non-PMS visits. Therefore, it is imperative that the immunization administration (IA) code(s) are separately reported in order to appropriately capture the resources expended in providing vaccines, including the work of vaccine counseling.
The Preventive Medicine Service Vaccine History
The vaccine-related component included in every preventive visit is the review of the vaccine history. This comprises collecting information on vaccines and vaccine preventable diseases that the patient has encountered and then comparing it to the Department of Health and Human Services (HHS)/Centers for Disease Control and Prevention (CDC) “Recommended Immunization Schedule”. Doing so then allows the provider to determine which vaccines are required or recommended as part of the PMS medical decision making process. Just as the history and physical examination yield a “well child” diagnosis, so does the patient’s general vaccine history yield a recommendation of “required vaccines.” The PMS component related to vaccines ends at this point.
Counseling on Specific Vaccines
All vaccine counseling services beyond the general vaccine history are included in the immunization administration (IA) codes (90460-90474). This includes, but is not limited to:
Obtaining information on potential contraindications to receiving a particular vaccine(s)
Reviewing/discussing the relevant CDC Vaccine Information Statement(s) (VIS)
Reviewing/discussing risks and benefits of specific vaccine(s)
Obtaining informed consent for each vaccine(s) administered
Addressing all other patient/parent concerns and questions related to vaccines and immunization administration
For this reason, when vaccines are given at the time of a preventive medicine service, the IA code(s) must be separately reported from the PMS code so that the provider can be appropriately paid for the work involved in vaccine counseling.
For questions, please contact the AAP Coding Hotline at firstname.lastname@example.org.
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