Correctly Code for Vaccinations

Proper coding for vaccinations involves coding for the administration of the vaccine, selection of specific vaccine or toxoid product codes, applying the appropriate diagnosis codes and using evaluation and management (E/M) codes if appropriate.

But unless a patient has experienced a specific exposure to an infectious agent such as tuberculosis (011.9) or meningococcus (036.9), the best approach to getting paid for the prophylactic administration of vaccinations is to seek reimbursement directly from the patient, says our panel of coding professionals. (See box on page 5 for more information on collecting fees up front.)

To correctly code for vaccinations, the immunization administration codes (90471 and 90472) should both be used when more than one vaccine is given on the same day.

90471 immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections and/or intranasal or oral administration); one vaccine (single or combination vaccine/toxoid), and

90472 each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure).

If a vaccine involves a series of injections over time, then use the 90471 code for each subsequent administration, advises Sheldon Schmidt, billing manager for Badger Billing Services, located in Mequon, Wis.

Vaccine and toxoid codes in the 90476-90748 series are for specific products. The codes identify various vaccines and toxoids by dosage (for example, adult vs. pediatric), administration route (intranasal vs. intramuscular), and vaccine formulation (split vs. whole virus). Its important to review closely all the codes to make sure youre selecting the right one, Schmidt recommends.

Some, such as 90636 (hepatitis A and hepatitis B vaccine, adult dosage, for intramuscular use), for example, combine more than one product. The coding choice for administration of only a hepatitis A vaccine, for example, is one of the three other hepatitis A codes:

90632 hepatitis A vaccine, adult dosage, for intramuscular use;

90633 hepatitis A vaccine, pediatric/adolescent dosage-2 dose schedule, for intramuscular use; or

90634 hepatitis A vaccine, pediatric/adolescent dosage-3 dose schedule, for intramuscular use.

Use 90749 (unlisted vaccine/toxoid) for products that dont have a specific code.

There also are specific diagnosis codes that relate to the need for vaccines. Those in the V03.0 to V06 series involve the need for prophylactic vaccination and inoculation against bacterial (V03.0 to V03.9); certain (V04.0 to V04.8); single (V05.0 to V05.9); and combinations of (V06.0 to V06.9) diseases. Codes in the V01.0 to V01.9 range address contact with or exposure to communicable diseases.

As with the vaccine product codes, its important to carefully review the ICD-9 codes and select the appropriate diagnosis.

When a patient is receiving a vaccine because he or she has been exposed to an infectious disease, the appropriate V01.0 to V01.9 code should be the primary [...]

- Published on 2000-03-01