When verifying administration codes 90460-90461, what must the auditor confirm?

When verifying administration codes 90460-90461, an auditor must confirm that counseling was performed and that the patient is 18 years old or younger. These specific codes are used for the administration of vaccines, particularly those that require counseling about the disease and its prevention.

The requirement for the patient's age, specifically being 18 years old or younger, ties directly to the guidelines set forth for these codes. They are designed to capture not just the act of administering the vaccine but also the additional work involved in counseling the patient or their guardian about the immunization and its importance. This is especially critical in pediatric populations, as the objectives include ensuring informed consent and addressing any questions or concerns that may arise regarding the vaccine.

In contrast, other scenarios, such as administering the vaccine in a group setting or being involved in a clinical trial, do not align with the specific requirements outlined for these administration codes. The age limit of 21 years is irrelevant because the codes specifically target a younger demographic, further emphasizing the focus on counseling and patient education in this age group. Thus, confirming that counseling was performed and that the patient is indeed 18 years old or younger is essential for proper coding and reimbursement.