CCA Exam - CPT Coding

Code anesthesia for upper abdominal ventral hernia repair. 00750 Anesthesia for hernia repairs in upper abdomen; not otherwise specified 00752 Anesthesia for hernia repairs in upper abdomen; lumbar and ventral hernias and/or wound dehiscence 00830 Anesthesia for hernia repairs in lower abdomen; not otherwise specified 00832 Anesthesia for hernia repairs in lower abdomen; ventral and incisional hernias

00752

Patient presents to the hospital for debridement of a diabetic ulcer of the left ankle. The patient has a history of recurrent ulcers. Medication taken by the patient includes Diabeta, and the patient was covered in the hospital with insulin sliding scales. The decubitus ulcer was debrided down to the bone. 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 cm2 or less 11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 cm2 or less +11046 Each additional 20 cm2 thereof (List separately in addition to code for primary procedure.) (Use 11046 in conjunction with 11043.) +11047 Each additional 20 cm2, or part thereof (List separately in addition to code for primary procedure.) (Use 11047 in conjunction with 11044.)

11043

Patient presents to the operating room for excision of a 4.5 cm malignant melanoma of the left forearm. A 6 cm x 6 cm rotation flap was created for closure. 11606 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm 14020 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less 14021 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm 14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm 15100 Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, of 1% of body area of infants and children

14301

Facelift utilizing the superficial musculoaponeurotic system (SMAS) flap technique. 15788 Chemical peel, facial; epidermal 15825 Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap) 15828 Rhytidectomy; cheek, chin, and neck 15829 Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap

15829

Patient presents to the operating room where the physician performed, using imaging guidance, a percutaneous breast biopsy utilizing a rotating biopsy device. 19000 Puncture aspiration of cyst of breast 19081 Biopsy, breast, with placement of breast localization device(s) (eg., clip, metallic pellet), when performed, and imaging of the biopsy specimen, percutaneous; first lesion, including stereotactic guidance 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, one or more lesions 19125 Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion 19283 Placement of breast localization device(s) (eg., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidance

19081

Open I&D of a deep abscess of the cervical spine 10060 Incision and drainage of abscess; simple or single 10140 Incision and drainage of hematoma, seroma or fluid collection 22010 Incision and drainage, open, of deep abscess (subfascial), posterior spine: cervical, thoracic, or cervicothoracic 22015 Incision and drainage, open, of deep abscess (subfascial), posterior spine; lumbar, sacral, or lumbosacral

22010

Chronic nontraumatic rotator cuff tear. Arthroscopic procedure of the shoulder with removal of foreign body and open rotator cuff repair 23410 Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; acute 23412 Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic 29821 Arthroscopy, shoulder, surgical; synovectomy, complete 29823 Arthroscopy, shoulder, surgical; debridement, extensive 29819 Arthroscopy, shoulder, surgical; with removal of loose body or foreign body 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair -59 Distinct procedural service

23412, 29819-59

Patient presents to the emergency room following a fall from a tree. X-rays were ordered for the left upper arm, which showed a fracture of the humerus shaft. The emergency room physician performed a closed reduction of the fracture and placed the patient in a long arm spica cast. Code the procedures, excluding the X-ray. 24500-LT Closed treatment of humeral shaft fracture; without manipulation (left side) 24505-LT Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction (left side) 24515-LT Open treatment of humeral shaft fracture with plate/screws, with or without cerclage (left side) 29065-LT Application, cast; shoulder to hand (long arm) (left side)

24505-LT

Patient has been diagnosed with metastatic laryngeal carcinoma. Patient underwent subtotal supraglottic laryngectomy with radical neck dissection. 31365 Laryngectomy; total with radical neck dissection 31367 Laryngectomy; subtotal supraglottic, without radical neck dissection 31368 Laryngectomy; subtotal supraglottic, with radical neck dissection 31540 Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis

31368

Tracheostoma revision with flap rotation 31613 Tracheostoma revision; simple, without flap rotation 31614 Tracheostoma revision; complex, with flap rotation 31750 Tracheoplasty; cervical 31830 Revision of tracheostomy scar

31614

Patient was admitted with hemoptysis and underwent a bronchoscopy with transbronchial lung biopsy. Following the bronchoscopy, the patient was taken to the operating room where a left lower lobe lobectomy was performed without complications. Pathology reported large cell carcinoma of the left lower lobe. 31625 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy, single or multiple sites 31628 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobe 32405 Biopsy, lung or mediastinum, percutaneous needle 32440 Removal of lung, pneumonectomy 32480 Removal of lung, other than total pneumonectomy, single lobe (lobectomy) 32484 Removal of lung, other than total pneumonectomy, single segment (segmentectomy)

31628, 32480

Patient complains of recurrent syncope following carotid thromboendarterectomy. Patient returns 2 weeks after initial surgery and undergoes repeat carotid thromboendarterectomy. 33510 Coronary artery bypass, vein only single coronary venous graft 35201 Repair blood vessel, direct; neck 35301 Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision 35390 Reoperation, carotid, thromboendarterectomy, more than 1 month after original operation

35301

Blood transfusion of three units of packed red blood cells 36430 Transfusion, blood or blood components 36455 Exchange transfusion; blood, other than newborn 36460 Transfusion, intrauterine, fetal

36430

Two-year-old patient returns to the hospital for cleft palate repair where a secondary lengthening procedure takes place. 40720 Plastic repair of cleft lip/nasal deformity; secondary, by re-creation of defect and reclosure 42145 Palatopharyngoplasty 42220 Palatoplasty for cleft palate; secondary lengthening procedure 42226 Lengthening of palate and pharyngeal flap

42220

Tonsillectomy on a 14-year-old 42820 Tonsillectomy and adenoidectomy; under age 12 42821 Tonsillectomy and adenoidectomy; age 12 or over 42825 Tonsillectomy, primary or secondary; under age 12 42826 Tonsillectomy, primary or secondary; age 12 or over

42826

Patient has a history of hiatal hernia for many years, which has progressively gotten worse. The decision to repair the hernia was made, and the patient was sent to the operating room where the repair took place via the thorax and abdomen. 39503 Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and with or without creation of ventral hernia 39545 Imbrication of diaphragm for eventration, transthoracic or transabdominal, paralytic or nonparalytic 43332 Repair, paraesophageal hiatal hernia, via laparotomy, except neonatal; without implantation of mesh or other prosthesis 43336 Repair, paraesophageal hiatal hernia, via thoracoabdominal incision, except neonatal; without implantation of mesh or other prosthesis

43336

Patient presents to the emergency room with right lower abdominal pains. Emergency room physician suspects possible appendicitis. Patient was taken to the operating room where a laparoscopic appendectomy was performed. Pathology report was negative for appendicitis. 44950 Appendectomy 44970 Laparoscopy, surgical, appendectomy 44979 Unlisted laparoscopy procedure, appendix 49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing

44970

Patient was admitted for right upper quadrant pain. Workup included various X-rays that showed cholelithiasis. Patient was taken to the operating room where a laparoscopic cholecystectomy was performed. During the procedure, the physician was unable to visualize through the ports, and an open cholecystectomy was elected to be performed. An intraoperative cholangiogram was performed. Pathology report states acute and chronic cholecystitis with cholelithiasis. 47605 Cholecystectomy with cholangiography 47563 Laparoscopy, surgical; cholecystectomy with cholangiography

47605

Laparoscopic repair of umbilical hernia 49580 Repair umbilical hernia, under age 5 years, reducible 49585 Repair umbilical hernia, age 5 years or over, reducible 49652 Laparoscopy, surgical, repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion when performed); reducible 49654 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion when performed); reducible

49652

Patient undergoes partial nephrectomy for carcinoma of the kidney. 50220 Nephrectomy, including partial ureterectomy, any open approach including rib resection 50234 Nephrectomy with total ureterectomy and bladder cuff; through same incision 50240 Nephrectomy, partial 50340 Recipient nephrectomy (separate procedure)

50240

Patient presented to the operating room where an incision was made in the epigastric region for a repair of ureterovisceral fistula. 50520 Closure of nephrocutaneous or pyelocutaneous fistula 50525 Closure of nephrovisceral fistula (eg., renocolic), including visceral repair; abdominal approach 50526 Closure of nephrovisceral fistula, including visceral repair; thoracic approach 50930 Closure of ureterovisceral fistula (including visceral repair)

50930

Ureterolithotomy completed laparoscopically 50600 Ureterotomy with exploration or drainage (separate procedure) 50945 Laparoscopy, surgical ureterolithotomy 52325 Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg., ultrasonic or electrohydraulic technique) 52352 Cystourethroscopy, with urethroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)

50945

Patient presents to the operating room for fulguration of bladder tumors. The cystoscope was inserted and entered the urethra, which was normal. Bladder tumors measuring approximately 1.5 cm were removed. 50957 Ureteral endoscopy through established ureterostomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with fulguration and/or incision, with or without biopsy 51530 Cystotomy; for excision of bladder tumor 52214 Cystourethroscopy, with fulguration (including cyrosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands 52234 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of small bladder tumor(s) (0.5 up to 2.0 cm)

52234

Litholapaxy, 3 cm calculus 50590 Lithotripsy, extracorporeal shock wave 52317 Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; simple or small (< 2.5 cm) 52318 Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; complicated or large (over 2.5 cm) 52353 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)

52318

Placement of double-J stent 52320 Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus 52330 Cystourethroscopy (including ureteral catheterization) with manipulation, without removal of ureteral calculus 52332 Cystourethroscopy with insertion of indwelling ureteral stent (e.g., Gibbons or double-J type) 52341 Cystourethroscopy, with treatment of ureteral stricture (e.g., balloon dilation, laser electrocautery, and incision)

52332

Patient is admitted for contact laser vaporization of the prostate. The physician performed a TURP and transurethral resection of the bladder neck at the same time. 52450 Transurethral incision of prostate 52500 Transurethral resection of bladder neck 52648 Laser vaporization of prostate, including control of postoperative bleeding, complete 53500 Urethrolysis, transvaginal, secondary, open, including cystourethroscopy

52648

Excision of Cowper's gland 53220 Excision or fulguration of carcinoma of urethra 53250 Excision of bulbourethral gland (Cowper's gland) 53260 Excision or fulguration; urethral polyp(s), distal urethra 53450 Urethromeatoplasty, with mucosal advancement

53250

Patient undergoes laparoscopic orchiopexy for intra-abdominal testes. 54650 Orchiopexy, abdominal approach, for intra-abdominal testis 54692 Laparoscopy, surgical; orchiopexy for intra-abdominal testis 54699 Unlisted laparoscopy procedure, testis 55899 Unlisted procedure, male genital system

54692

Patient is at a fertility clinic and undergoes intrauterine embryo transplant. 58322 Artificial insemination; intra-uterine 58323 Sperm washing for artificial insemination 58679 Unlisted laparoscopy procedure, oviduct, ovary 58974 Embryo transfer, intrauterine

58974

Amniocentesis 57530 Trachelectomy, amputation of cervix (separate procedure) 57550 Excision of cervical stump, vaginal approach 59000 Amniocentesis, diagnostic 59200 Insertion of cervical dilator (eg., laminaria, prostaglandin) (separate procedure)

59000

Cesarean delivery with antepartum and postpartum care 59400 Routine obstetric care including antepartum care, vaginal delivery and postpartum care 59510 Routine obstetric care including antepartum care, cesarean delivery, and postpartum care 59514 Cesarean delivery only 59610 Routine obstetric care including antepartum care, vaginal delivery and postpartum care, after previous cesarean delivery

59510

Left carotid artery excision for tumor of carotid body 60600 Excision of carotid body tumor; without excision of carotid artery 60605 Excision of carotid body tumor; with excision of carotid artery 60650 Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal 60699 Unlisted procedure, endocrine system

60605

Patient is admitted to the hospital with facial droop and left-sided paralysis. CT scan of the brain shows subdural hematoma. Burr holes were performed to evacuate the hematoma. 61150 Burr hole(s) or trephine; with drainage of brain abscess or cyst 61154 Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural 61156 Burr hole(s); with aspiration of hematoma or cyst, intracerebral 61314 Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural or subdural

61154

Patient has rhinorrhea, which requires repair of the CSF leak with craniotomy. 62010 Elevation of depressed skull fracture; with repair of dura and/or debridement of brain 62100 Crainotomy for repair of dural/cerebrospinal fluid leak, including surgery for rhinorrhea/otorrhea 63707 Repair of dural/cerebrospinal fluid leak, not requiring laminectomy 63709 Repair of dural/cerebrospinal fluid leak or pseudomeningocele, with laminectomy

62100

Spinal tap 62268 Percutaneous aspiration, spinal cord cyst or syrinx 62270 Spinal puncture, lumbar diagnostic 62272 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter) 64999 Unlisted procedure, nervous system

62270

Injection of anesthesia for nerve block of the brachial plexus. 64413 Injection, anesthetic agent; cervical plexus 64415 Injection, anesthetic agent; brachial plexus, single 64510 Injection, anesthetic agent; stellate ganglion (cervical sympathetic) 64530 Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring

64415

Patient presents to the hospital for a two-view chest X-ray for a cough. The radiology report comes back negative. What would be the correct codes to report to the insurance company? 71045 Radiologic examination, chest; single view 71046 Radiologic examination, chest; two views 71047 Radiologic examination, chest; three views 71048 Radiologic examination, chest; four or more views

71046

SPECT bone imaging 77080 Dual energy X-ray absorptiometry (DXA), bone density study, one or more sites; axial skeleton (e.g., hips, pelvis, spine) 76977 Ultrasound bone density measurement and interpretation, peripheral site(s), any method 78300 Bone and/or joint imaging; limited area 78320 Bone and/or joint imaging; tomographic (SPECT)

78320

A physician orders a lipid panel on a 54-year-old male with hypercholesterolemia, hypertension, and a family history of heart disease. The lab employee in his office performs and reports the total cholesterol and HDL cholesterol only. 80061 Lipid panel; this panel must include the following: Cholesterol, serum, total (82465); Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718); Triglycerides (84478) 82465 Cholesterol, serum or whole blood, total 83718 Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) 84478 Triglycerides -52 Reduced services

82465, 83718

Creatinine clearance 82550 Creatine kinase (CK), (CPK); total 82565 Creatinine; blood 82575 Creatinine; clearance 82585 Cryofibrinogen

82575

Vitamin B12 82180 Ascorbic acid (vitamin C), blood 82607 Cyanocobalamin (vitamin B12) 84590 Vitamin A 84591 Vitamin, not otherwise specified

82607

Hepatitis C antibody 86803 Hepatitis C antibody 86804 Hepatitis C antibody; confirmatory test (e.g., immunoblot) 87520 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, direct probe technique 87522 Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification

86803

An established 3-year-old patient was seen by his pediatrician for a DTaP immunization. The pediatrician also provided documentation for a minimal level office visit in addition to the immunization. 90696 Diptheria, tetanus toxioids, acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when adminterested to children 4 through 6 years of age, for intramuscular use 90700 Diptheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years for intramuscular use 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) 90460 Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified healthcare professional 99212 Office or other outpatient visit for the evaluation and management of an established patient with a problem focused history, problem focused examination, and straightforward medical decision making -25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the other service

90700, 90471, 99211-25 Separate codes exist for the administration of vaccines and toxoids and for the toxoid product themselves. Code 90700 is used to identify the actual type of immunization which was DTaP. Code 90471 is used to report the administration of the immunization or toxoid. When a significant separately identifiable E/M service is performed, the appropriate E/M services code should also be used appended with modifier 25 in addition to the immunization administration and toxoid substance codes. Code 99211 is reported to identify the medical E/M office visit that was provided to the patient. Modifier -25 is used to signify it was a significant and separately identifiable E/M services by the same physician.

The patient's physician performed a balloon angioplasty (PTCA) with insertion of drug-eluting stent in the right coronary artery. 92920 Percutaneous transluminal coronary angioplasty; single major coronary artery or branch 92924 Percutaneous transluminal coronary artherectomy, with coronary angioplasty when performed; single major coronary artery or branch 92928 Percutaneous transcatherter placement of intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery or branch 92933 Percutaneous transluminal coronary artherectomy, with intracoronary stent, with coronary angioplasty when performed; single major coronary artery or branch -RC Right coronary artery

92928-RC

Comprehensive electrophysiologic evaluation (EPS) with induction of arrhythmia 93618 Induction of arrhythmia by electrical pacing 93619 Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple electrode catheters, without induction or attempted induction of arrhythmia 93620 Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording +93623 Programmed stimulation and pacing after intravenous drug infusion (list separately in addition to code for primary procedure) 93640 Electrophysiologic evaluation of single- or dual-chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of initial implantation or replacement

93620

The patient is on vacation and presents to a physician's office with a lacerated finger. The physician repairs the laceration and gives a prescription for pain control and has the patient follow up with his primary physician when he returns home. The physician completes problem-focused history and physical examination with straightforward medical decision making. Also checked is a laceration repair for a 1.5 cm finger wound. 99201 New patient office visit with a problem-focused history, problem-focused examination, and straightforward medical decision making 99212 Established patient office visit with a problem-focused history, problem-focused examination, and straightforward medical decision making 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet); 2.5 cm or less 13131 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 1.1 cm to 2.5 cm

99201, 12001

A patient receives individual psychotherapy for 30 minutes. The doctor also provides medical E/M services for this established patient that includes a problem-focused history, a problem-focused examination, and straightforward level of medical decision making 99211 Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified healthcare professional. 99212 Office or other outpatient visit for the evaluation and management of an established patient with a problem focused history, problem focused examination, and straightforward medical decision making 99213 Office or other outpatient visit for the evaluation and management of an established patient with an expanded problem focused history, expanded problem focused examination, and medical decision making of low complexity 90832 Psychotherapy, 30 minutes with patient 90833 Psychotherapy, 30 minutes with patient when performed with an evaluation and management service

99212, 90833

A 69-year-old established female patient presents to the office with chronic obstructive lung disease, congestive heart failure, and hypertension. The physician conducts a comprehensive history and physical examination and makes a medical decision of moderate complexity. Physician admits the patient from the office to the hospital for acute exacerbation of CHF. 99212 Established office visit for problem-focused history and exam, straightforward medical decision making 99214 Established office visit for a detailed history and physical exam, moderate medical decision making 99222 Initial hospital care for comprehensive history and physical exam, moderate medical decision making 99223 Initial hospital care for comprehensive history and physical exam, high medical decision making

99222 According to CPT guidelines, when a patient is admitted to the hospital on the same day as an office visit, the office visit is not billable.Tonsillectomy on a 14-year-old 42820Tonsillectomy and adenoidectomy; under age 1242821Tonsillectomy and adenoidectomy; age 12 or over42825Tonsillectomy, primary or secondary; under age 1242826Tonsillectomy, primary or secondary; age 12 or over

Patient presents to the emergency room complaining of right forearm/elbow pain after racquetball last night. Patient states that he did not fall but overworked his arm. Past medical history is negative and the physical examination reveals the patient is unable to supinate. A four-view X-ray of the right elbow is performed and is negative. The physician signs the patient out with right elbow sprain. Prescription of Motrin is given to the patient. 73040 Radiologic examination, shoulder, arthrography, radiological supervision and interpretation 73070 Radiologic examination, elbow; two views 73080 Radiologic examination, elbow; complete, minimum of three views 99281 E/M visit to emergency room-problem-focused history, problem-focused exam, straightforward medical decision 99282 E/M visit to emergency room-expanded problem-focused history, expanded problem-focused exam, and medical decision of low complexity -25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service

99281-25, 73080

Established 42-year-old patient comes into your office to obtain vaccines required for his trip to Sri Lanka. The nurse injects intramuscularly the following vaccines: hepatitis A and B vaccines, cholera vaccine, and yellow fever vaccine. As the coding specialist, what would you report on the CMS 1500 form?

administration of two or more single vaccines; vaccine products for hepatitis A and B, cholera, and yellow fever