---
title: 90465 Debate Revisited
description: 90465 Debate Revisited
---

[Confessions of a Pediatric Management Consultant... Where fame and fortune await those who help keep pediatric practices alive and independent! ](https://chipsblog.pcc.com)

# [90465 Debate Revisited](https://chipsblog.pcc.com/90465-debate-revisited)

 Written by [Chip Hart](https://chipsblog.pcc.com/author/chip-hart) | Dec 19, 2008 5:09:19 PM

I have some very interesting continued news about TriCare and I've had a piece about Main Street Vaccines building for a week or two, now, but I have to address this issue first.

[Earlier this year](https://chipsblog.pcc.com/imms-admin-90465-vs-90471/), I wrote about how there is a measureable difference between the payments for a 90465/90471 and 90466/90472.  Although $1.50 to $2.50 a procedure doesn't seem like much, when you do 10,000 of them, it adds up.  Especially for pediatricians.

So why are there still *so many pediatricians who don't even use the proper immunization administration code?!*  Ignore, for a moment, the fact that not using a 90465 properly is bad coding practice.  Ignore, for a moment, that you are failing to document with your code that you spent time counseling.  *You are losing money.*

How often should a practice be billing the 90465 vs. a 90471?  It's difficult to know for sure - what percentage of the kids you immunize are under 8 years old?  Is even a modicum of imms counseling part of your clinical protocol?  Some of our clients insist that they "never" do counseling except for the first in a series of shots.  I not only think that they are factually wrong, but if they *were* right, they'd be missing an important clinical opportunity.

I don't know the answer, but I have a feeling that most pediatric practices ought to be doing as many, or more, 90465s and 90471s.  Just a gut instinct.  In reality, though, practices are all over the map.  I could simply give you the averages of everything, but the variance is so large, I think it would be worthless.  Let me show you...

...below, I took a random sampling of PCC clients and grouped them into segments based on their ratios of 90465:90471 procedures.  Then mapped them out.  So, on the left side of the graph below (click on it to zoom in) are practices who do very few - sometimes none! - 90465 procedures.  On the other end, you'll find practices who do more 90465s than 90471s - you'll see that some do 4-5-7x more.

<https://chipsblog.pcc.com/hubfs/Imported_Blog_Media/90465v90471.png>

I won't judge who is right and wrong...ok, I take that back.  I'll bet that the overwhelming majority of practices who have a 90465:90471 ratio under 75% are mis-coding and losing money.  Under 50%? Under 25%?  And these are PCC clients, they are supposed to be better.I can't understand it.

Anyone want to help explain this to me?  Do you really not do *any* physician imms  counseling in your office, and why not?

Sigh.

[View full post](https://chipsblog.pcc.com/90465-debate-revisited)

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