90460 vs 90471

[Debi]

I am wondering if I could get clarification for 90460 and 90461 versus the 90471 and 90472. I work for a clinic, and we usually just bill the 90471 and 90472 for all of our administrations. We have received a denial for the claim, so my supervisor asked me to check to see what the difference is between the two codes.

Would 90460 and 90461 be used for immunizations that are given with well child exams and office visits?

And would 90471 and 90472 be used for just the immunizations?

Can anyone please help with clarification for when to use the 90460 and 90471?

Thank you,

 

[Laureen]

Use 90460/90461 if your patient is 18 or younger and counseling was provided by the physician or nurse. Because nurses and other professionals can use these codes you would not report 99211 with it.

Use 90471/90472 if no counseling was provided or the patient is over 18.

 

[JanetU]

I do pediatric clinic coding every day, and for well child visits we assign the appropriate preventive visit with modifier 25, then assign the 90460/90461 codes. Only exception for us is with Medicaid, and we code only the 90460 code (patients eligible for VFC), again with the 25 modifier on the preventive visit code.