Vaccination/Immunization Coding Considerations

Vaccines have been in the news recently, making it a good time to take a look at our coding for vaccinations. In our Alphabetic Index, we see that Vaccination has “prophylactic” in parentheses, noting a non-essential modifier here.

Under Vaccination we have several entries: complication or reaction, delayed, encounter for, not done, and partial. We are able to assign partial vaccination status specifically for COVID-19.

Looking at the Tabular List, Z23, Encounter for immunization, we find a code with which we are all probably familiar. Here we have a note instructing us to code first any routine childhood examination. This note gives us sequencing guidance. We also have a note that instructs us, if applicable, to code first any encounter for immunization safety counseling.

Code Z71.85, Encounter for immunization safety counseling, is referenced. Z23 also includes a note, reminding the coder that procedure codes are required to identify the types of immunizations given.

For PCS coding, from the index, Immunization and Vaccination both instruct us to see Introduction of Serum, Toxoid and Vaccine. For our PCS coding, we need to know the site of the administration. Generally, when we think of vaccinations, we may think only of intramuscular. In a May 2021 article by Gavi, the Vaccine Alliance titled “The point of it: Why do vaccine delivery methods vary?” they shed some light on the other types of administration, noting subcutaneous, oral, and intranasal, to name a few. Depending on the vaccine site, you may need to select the approach value when building your PCS code.

Most commonly the approach value will be 3 for Percutaneous. Our substance value will be 4 for Serum, Toxoid, and Vaccine. Depending on the vaccine we are assigning for, we may have a qualifier value specific to type. For example, for our intramuscular administered influenza vaccine, we would assign 3E02340, with our qualifier value noting specifically influenza vaccine.

Our COVID-19 vaccines are coded in the New Technology section with specific values for COVID-19 vaccine, Dose 1, Dose 2, Dose 3, and Booster. 

Looking at our CPT® coding, we would find Immunization Administration for Vaccines/Toxoids at 90460-90480. Additional codes identifying specific vaccines and toxoids are found at code range 90476-91322. Generally, the vaccine administration codes are assigned in addition to the code(s) for the specific vaccine(s).

Be sure to review the CPT instructions and guidance for further information on specifics with evaluation and management (E&M) and modifier use. 

Since so many health topics have been in our recent news cycles, it presents the perfect opportunity to engage your coding staff on a clinical refresher and/or coding guideline review. Pull a topic from the headlines and organize a focused discussion on how to code it.

You can also have the coders pick a current topic and present information to their team. 

Programming note: Listen live today on Talk Ten Tuesday 10 Eastern for the Coding report with Christine Geiger.