Immunization Coding 2010 The Basics and Beyond. Richard H. Tuck, MD, FAAP. Disclosure Richard H. Tuck, MD, FAAP.
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Richard H. Tuck, MD, FAAP
The challenge: Maintaining a vaccine delivery system
Requires both Clinical and Business Skills
A physician with 50 newborns per year could give 2000 vaccines (>$90,000 potential cost)
Vaccines are now the second largest practice expense (non universal states)
The Margin must support the Mission - It can be financially profitable !
AMA identifies vaccines pending FDA approval ~ code assigned
V20.2 Well Child
+ Specific Vaccine V Codes
*See AAP document “The Business Case for Pricing Vaccines and Immunization Administration” www.cispimmunize.org
Underlined CPT codes can only be used for the first vaccine administered of any kind. The non-underlined codes indicate each subsequent vaccine administered. Only one of the underlined codes may be used per day.
RVU 2009 medicare RVU 2009 medicare
Screening RVU/ 2009 Medicare
Hearing testing - Select picture 92583 .91/ $31.30
Hearing testing – Puretone 92551 .29/ $10.46
Hearing testing – Puretone(threshold) 92552 .59/ $21.28
Vision screening 99173 .07/ $2.52
Developmental Screening 96110 .36/ $12.98
Hemoglobin 85018 .10/ $3.45
Urine (dip only) 81002 .08/ $2.78
Routine Venipuncture 36415 .26/ $9.17
Finger/Heel Stick 36416 .15/ $5.25
Immunization administration 90471/90465 .58/ $20.92
90472/90466 .29/ $10.46
Vaccine/Toxoid product 90476-90479
Injection/other 96372 .58/ $20.17
-25 modifier on E/M office visit code
+96372 Injection code
A 2-year old child with private insurance is seen in September for a contact dermatitis. He has not been seen since 9 months of age and you administer the following vaccines: MMR#1, Var#1, Hib#4, PCV#4, HepA#1, DTaP#4 and LAIV. A future well visit is scheduled for one month later before the patient leaves the office.
How would you code this encounter?