How do I add bivalent "baby" (6m-4y Pfizer and/or 6m-5y Moderna) COVID vaccines to my OP?

Last updated 1/18/23  by Suzanne Berman, MD FAAP

Caveats

This Does Not Give You Full OP Support for Bivalent Baby COVID Vaccines

Wait!  What about Moderna bivalent for 12-17?

Add new VIS reference(s)

Add the relevant product CPT code(s)

Add the relevant administration CPT code(s)

Add new vaccine product(s)

Add a vaccine lot

Check how administration looks

Other references

Miscellaneous troubleshooting

Simplified billing

Caveats

PLEASE READ THE WHOLE THING

PLEASE COMPLETE THE STEPS IN ORDER

• These instructions give instructions for creating recently EUA'd vaccines into your OP:

• Pfizer 6m-4 yr vaccine "Pfizer baby bivalent" (CVX 302)
• Moderna 6m-5y vaccine "Moderna baby bivalent"  (CVX 230)

If you're only going to be giving one or the other, save yourself some time and only input what you need.

• You have to have the proper privileges to edit these code sets.  If you don't have the options listed here, have your OP administrator give you the proper privilege(s).  

• For help on managing user permissions: https://op.knowledgeowl.com/help/managing-user-permissions
• The specific privilege to add/edit vaccines in the Vaccine Codes table is  Vacnames_Administration

This Does Not Give You Full OP Support for Bivalent Baby COVID Vaccines

Please understand that these changes will permit you to document and bill COVID bivalent vaccines contemporaneously.  HOWEVER, you will still have these issues until OP releases Full Support for Bivalent Baby COVID Vaccines:

• Even after OP releases full support for "bivalent baby COVID" vaccines and you have received all the above releases, you may continue to have the following issues:

• The vaccine may not go to your Immunization Registry if your state registry wants something different than what we have given you here.  Watch your immunization registry activity closely.   Errors here MIGHT be an OP issue, or they might be related to your immunization registry.

• Your payers or clearinghouse might reject new vaccines or new vaccine admin codes as "unrecognized codes."  This is NOT a problem with OP but of your clearinghouse not keeping up to date with their codeset.  We know that payers take months to load new COVID vaccine codes, particularly for children.

Add new VIS reference(s)

Practice Management -> Coded Values -> VIS name/version (be sure Allow Edits is checked)

Click +.

First, look for existing VIS entries for these COVID EUAs as below.   Update (edit) their entries to read as follows:

If you do not have VIS entries with Descriptions like these (unlikely, but possible), then Add them (+):

• Enter the data as above.
• In all cases, leave String ID and Numeric ID blank.  
• Put any number you want for Sort.  
• Leave Archived unchecked.

Data source:

https://www.cdc.gov/vaccines/programs/iis/code-sets/vis-barcode-lookup-table.html

While you have this window in OP open, take the opportunity to archive any deprecated/historical VIS you have.  Click the Archived check box for any VIS that are listed in the above link as "Historical."

If you want the current PDFs for these EUAs, you can get them here:

Add the relevant product CPT code(s)

Billing -> Procedure (CPT) Codes -> click Edit -> click +

Knowledge reference: https://op.knowledgeowl.com/help/add-edit-and-delete-cpt-codes#add-a-cpt-code

Add the relevant administration CPT code(s)

Billing -> Procedure (CPT) Codes -> click Edit -> click +

Knowledge reference: https://op.knowledgeowl.com/help/add-edit-and-delete-cpt-codes#add-a-cpt-code

Knowledge reference;

https://www.ama-assn.org/find-covid-19-vaccine-codes

Add new vaccine product(s)

Practice Management -> [Reference Data] More -> Vaccine Products -> New

Please add the fields exactly as they are listed here EXACTLY, even including punctuation, spaces, and capitalization.

**Please note: the NDCs given are what has been published as of 12/12/22.  It is possible you may get lots with new/different NDC numbers than what are listed here.  If so, use those numbers instead.

Help site reference: https://op.knowledgeowl.com/help/add-a-vaccine-to-the-vaccine-codes-table

Add a vaccine lot

Practice Management -> Manage vaccine inventory -> New

Check how administration looks

You will have to administer through the Immunization Order Management - Inventory tab. After you have administered the vaccine, look at the patient's immunization forecast.   You will see the bivalent baby vaccine in the Miscellaneous box while other COVID vaccines are in the COVID19 box.  THIS IS EXPECTED FOR NOW.

Other references

AAP "Cheat Sheet" (being continuously updated!)

• https://downloads.aap.org/AAP/PDF/COVID-19%20Vaccine%20Coding%20Chart.pdf

Miscellaneous troubleshooting

Please note that, until a future OP update (see This Does Not Give You Full OP Support for Bivalent Baby COVID Vaccines), you will see an erroneous vaccine administration code appear even if you have followed these directions.

• You may see 90460
• You may see 90471
• Or you may see  "Code not found" (EVEN THOUGH YOU HAVE ALREADY ADDED 0164A and 0173A)

Please note: "Code not found" in this context DOES NOT MEAN "YOU HAVE NOT ADDED 0164A/0173A."  It means "This is a COVID vaccine and OP doesn't know WHICH admin code to automagically add." You can STILL manually associate 0164A, 0173A, or whatever you need.

You will have to add the appropriate administration CPT code to match the vaccine CPT code.

Rather than doing it manually every time, I suggest using OP Aware/Advanced Workflow/"Block and Substitute" rules as follows:

For all payers:

• Every time you bill code 91317 (Pfizer baby bivalent)  -> Add code 0173A
• Every time you bill code 91316 (Moderna baby bivalent)  -> Add code 0164A

(For a quick refresher on OP Aware/Advanced Workflow/"Block and Substitute," go here:

https://op.knowledgeowl.com/help/advanced-workflow-rules-engine-op-aware-overview

Here's an example of a Advanced Workflow rule (for a different COVID vaccine):

Note that you need to put at least one insurance code (or [*] for all insurances).

Once OP has full support for bivalent vaccines (see This Does Not Give You Full OP Support for Bivalent Baby COVID Vaccines), you'll want to disable these rules -- otherwise, you'll have duplicate 0173A and 0164A.    You can easily insert an end date  (see red arrow in screenshot above).

Simplified billing

Once you have created the above OP Aware/Advanced Workflow/"Block and Substitute" rules, you'll STILL see something like this on the superbill (yes, this is expected):

…but after you convert the superbill to a claim, you'll see the added CPT code appear, like this:

[OP Aware rules only take effect at the claim level, NOT the superbill level!]

Finally, you can delete the excess 90460 code with two clicks.  (Or, if you want to be super-fancy, you can create a second OP Aware/Advanced Workflow/"Block and Substitute" rule to remove the extraneous 90460 when it's not accompanied by a proper non-COVID vaccine product code.)