Understanding the correct coding for flu shot administration is crucial for healthcare providers. While you might be searching for a “Diagnosis Code For Flu Shot,” it’s important to clarify that we’re actually discussing administration codes, specifically CPT codes that detail how to bill for the service of administering vaccines, like the flu shot. This guide will break down the essential CPT codes for flu shot administration, especially in pediatric settings where counseling is involved.
The primary codes for pediatric immunization administration with counseling are:
- 90460: This code is for immunization administration for patients 18 years and younger, using any route of administration. It includes counseling provided by a physician or qualified healthcare professional. This code is used for the first or only component of each vaccine or toxoid administered.
- +90461: This is an add-on code, used for each additional vaccine/toxoid component administered. It’s always listed in addition to the primary code (90460).
It’s vital to understand that these codes are reported per vaccine or toxoid component. CPT defines a “component” as each antigen in a vaccine that prevents a disease caused by a single organism. Combination vaccines, like some formulations of flu shots, contain multiple components.
You can report code 90460 multiple times if you are administering multiple first components. For instance, if a child receives a flu shot and another single-component vaccine, you would report 90460 for each as they are both “first components” in their respective administrations. Importantly, code 90460 isn’t just for combination vaccines; it applies to single-component vaccines like the flu vaccine, HPV vaccine, or pneumococcal conjugate vaccine as well, as long as counseling is provided to patients 18 and under. Code 90461 is then used for any subsequent components in combination vaccines.
For immunizations where face-to-face counseling by a physician or qualified healthcare professional is not provided, or for patients over 18 years of age, you should use codes 90471-90474. These codes are for administration only, without the counseling component.
Key Points to Remember About Codes 90460 and 90461
To use codes 90460 and 90461 correctly for vaccine counseling and administration, keep these points in mind:
- These codes only cover the administration of the vaccine. The cost of the vaccine product itself must be billed separately.
- Face-to-face counseling is a must. A physician or other qualified health professional (as defined by state licensure) must counsel the patient and/or their caregivers to use 90460-90461.
- If no counseling is provided, you must use administration codes 90471-90474 instead.
- Codes 90460-90461 are specifically for patients 18 years of age and under.
- Code 90460 is used for each separate administration of single-component vaccines and/or the first component of a combination vaccine.
- When administering combination vaccines, report 90460 for the first component and the add-on code 90461 for each additional component. You don’t need modifier -51 in this case.
- The route of administration (injection, oral, intranasal) is irrelevant. The codes cover “via any route of administration.”
Example of Administration Coding
Let’s consider an 11-year-old girl who comes in for her annual preventive care visit (99393). During the visit, the physician counsels both the child and her mother about the benefits and risks of the HPV vaccine (90649), Tdap vaccine (90715), and the seasonal flu vaccine (90660). This discussion is documented in the patient’s chart, and the mother consents to all vaccinations. A nurse then prepares and administers each vaccine, completes all necessary documentation and vaccine registry entries, and ensures there are no immediate adverse reactions.
In this scenario, the CPT codes reported would be:
- 99393 – Preventive service visit
- 90649 – HPV vaccine
- 90460 – Administration of the first component (1 unit) for HPV vaccine
- 90715 – Tdap vaccine
- 90460 – Administration of the first component (1 unit) for Tdap vaccine
- 90461 – Administration of the two additional components (2 units) for Tdap vaccine (Tdap is a combination vaccine)
- 90660 – Influenza vaccine, live, for intranasal use
- 90460 – Administration of the first component (1 unit) for the flu vaccine
This example clearly illustrates how to correctly apply codes 90460 and 90461 in a common pediatric vaccination scenario, including the flu shot. Remember, accurate coding ensures proper billing and reimbursement for the valuable services you provide in protecting public health through immunization.
