Bring Your Measles Coding Up to Speed, Part 2
Here’s what to do when immunizations don’t go forward. In the first part of this series on measles coding, we looked at how to code for immunization encounters that go smoothly. In this second article, we’ll look at how to code for immunization encounters where the patient does not receive the measles, mumps, rubella (MMR) vaccine, what to do if a patient contracts the disease, and how to correctly use a history code if a patient had measles and later reports to your provider for another condition. Learn the Nuances of the Z28 Codes From a coding perspective, things can get tricky if a patient reports for a measles immunization and the immunization is not carried out. When this happens, you’ll turn to the Z28 (Immunization not carried out and underimmunization status) code group and pick out the appropriate code to describe one of three reasons why the immunization did not take place. But as simple as that sounds, there are a number of considerations you need to keep in mind. The first code you might use is Z28.3 (Underimmunization status). However, ICD-10-CM does not tell you how or when to apply it. So, you will need to defer to your provider before using it. Chances are, they will consult an immunization schedule, such as the one provided by the Centers for Disease Control and Prevention (CDC), to make the determination. Next, you’ll need to apply the correct code to report why the immunization failed to take place. Fortunately, rationales for a patient not to get vaccinated essentially boil down to the three reasons reflected in the codes. Unvaccinated due to health reasons: Dependent on the reason, you will use one of the following as appropriate: Unvaccinated due to philosophical/religious reasons: Your application of Z28.82 (Immunization not carried out because of caregiver refusal) and Z28.21 (Immunization not carried out because of patient refusal) if your patient is old enough to make their own wishes known is pretty straightforward. So, too, is your use of Z28.9 (Immunization not carried out for unspecified reason) if the patient or caregiver declines the immunization without a specified reason. And if the patient’s refusal is on religious grounds, you can use Z28.1 (Immunization not carried out because of patient decision for reasons of belief or group pressure). But it is important to note this code “can be used with or without the patient’s consent” according to The American Academy of Pediatrics (AAP). That’s because of the code’s inclusion term, “Immunization not carried out because of religious belief,” according to the AAP. Unvaccinated because the vaccine is unavailable: Synonyms for Z28.83 (Immunization not carried out due to unavailability of vaccine) tell you to use the code in the event that the vaccine is unavailable or delayed because of manufacturing or delivery problems. Know the Subtleties of Measles Dx Coding Should your practice deal with a confirmed diagnosis of measles, you’ll turn to one of the eight codes listed in the B05.- (Measles) category. For patients who are simply presenting with common symptoms such as the typical red skin rash and a cough, sore throat, and/or fever, you’ll use B05.9 (Measles without complications). However, many of the B05.- codes are combination codes for use when the patient has one of the complications associated with the condition, such as B05.3 (Measles complicated by otitis media), which is commonly seen in pediatric patients. As the B05.- codes have no instructions, and in the absence of any Code also notes, you will also need to add an additional code for the complication, such as adding an additional code from H65.- (Nonsuppurative otitis media) or H66 (Suppurative and unspecified otitis media) to B05.3 as appropriate. Remember: Don’t confuse measles, also known as rubeola, with the similar-sounding rubella, or German measles. They are two entirely different conditions, with the latter being coded to B06.- (Rubella). Don’t Rush to Apply History Codes Using a history code when the patient has had the measles is a little more complex. Use of Z86.19 (Personal history of other infectious and parasitic diseases) is very much dependent on the reason why the patient is seeking treatment from your provider. A patient who had measles as a child who then visits your provider for a condition completely unrelated to the condition would not be coded with Z86.19. However, consider the following scenario: Your provider sees a patient for hearing problems or an intellectual disability related to encephalitis, which your provider determines is a sequela of childhood measles. In this situation, you would code the condition being treated as the primary diagnosis with Z86.19 as a secondary. This complies with the instructional note to parent code Z86.1- (Personal history of infectious and parasitic diseases), which tells you that you can use codes in the group for “conditions classifiable to A00-B89, B99,” which includes the B05.- (Measles) codes. Bruce Pegg, BA, MA, CPC, CFPC, Managing Editor, AAPC
