Pediatric Coding Alert

Time to get your Z28 understanding back on track.

While the overall number of children vaccinated in the U. S. is extremely high, the most recent National Immunization Survey-Child (NIS-Child), conducted in 2017, points to an alarming trend: the number of unvaccinated children in America is on the rise.

In the last 20 years, the percentage of 19- to 35-month-olds who have received no vaccinations has risen from 0.3 percent for children born in 2001 through 0.9 percent for those born in 2011 to a high of 1.3 percent for children born in 2015 (source: www.cdc.gov/mmwr/volumes/67/wr/mm6740a4.htm?s_cid=mm6740a4_e).

If these statistics have you thinking that it’s time to brush off your understanding of how to code encounters your provider has with unvaccinated or under-immunized patients, we’re with you. So, here are four questions that will help you sharpen your knowledge of this unusual but significant coding scenario.

Question 1: A patient arrives for a 24-month preventive medicine visit. The pediatrician examines the patient’s records and notices that they are behind on their immunization schedule. What code should you report?

Question 2: A different patient reports for a 1-year preventive medicine visit. At the visit, your pediatrician determines the child is currently too sick to receive the immunizations scheduled for the visit, so your office schedules the patient to return when they are well for the immunizations. How would you code this encounter?

Question 3: Which codes would you report if a patient’s caregiver refused a patient’s immunization on religious grounds or on the belief that ingredients in the vaccinations can cause autism spectrum disorder (ASD) in children?

Question 4: Two HCPCS codes can also be used in scenarios where a provider does not administer an immunization. What are they, and when would you use them?

Think you know the answers?