Q: “Do you sequence the vaccine first and then the route of administration? What order should be followed?”
A: Regrettably, there isn’t a specific guideline that answers this question and there isn’t anything in the CPT Manual that tells you how to list them in a particular order. Usually, you’ll discover answers when you start asking insurance carriers for their guidelines. For example, Medicare will state to “List them in RVU order.” RVU – Relative Value Units, usually corresponds to dollar value. You would list the most expensive one first and work your way down price-wise.
There is a Work RVU Calculator located on the AAPC website.
The work RVU calculator provides a quick analysis of work relative value units associated with CPT and HCPCS Level II codes. By entering the appropriate code and number of units associated with it, you will receive the total work RVUs and individual work RVU value for that code. The RVU calculation results are based on the values supplied by CMS in the 2021 National Physician Fee Schedule Relative Value File.
In most clinics, they code the product, the actual toxin that they’re injecting. That sounds harmful to call it a toxin, but it’s a toxoid. The Tdap, DTaP, Hib, IPV – whatever the substance is that they’re injecting, that’s usually more expensive than the actual needle stick. List those first and list them in order (RVU order or dollar-value order) and then, list the administration codes.
Vaccine administration is listed in Appendix Q, with their associated vaccine code descriptors, vaccine administration codes, vaccine manufacturer, vaccine name, National Drug Code, Labeler Product ID, and the interval between doses.
When you’re listing your administration codes, the important thing to remember is that you only get to code one initial administration code. For example, let’s consider a situation where a child comes in for vaccines in late fall and the office decides they will also be giving the child a nasal flu vaccine. In this case, whichever one they administer first is what you’re going to use as your initial administration code.
If a significant separately identifiable evaluation and management service (eg, new or established patient office or other outpatient services, office or other outpatient consultations, emergency department services, preventive medicine services) are performed, the appropriate E/M service code should be reported in addition to the vaccine and toxoid administration codes.
Even if several vaccines are administered using different routes, you only have one initial. You can only do one thing first, so make sure you’re only reporting one initial code. There isn’t any specific guideline saying that one code goes first before the other code.