ICD-10 Code Z23 Immunizations

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pedscoder

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There is much debate within our practice about the appropriate use of Z23 Encounter for immunizations. Chapter guidelines state this code "indicates that a patient is being seen to receive a prophylactic inoculation against a disease". Also, "Code Z23 may be used as a secondary code if the inoculation is given as a routine part of preventive health care, such a a well-baby visit." When you go to the code itself, there is a further instruction to "Code first any routine childhood examination". Our interpretation is that this means if a immunization is given in the context of a routine well child visit, then the dx linked to the immunization and the administration CPT codes should be the Z00.121 or Z00.129 which are the dxs for routine exam. And Z23 can be used secondary but is optional. AND Z23 would be used when an immunization is given anytime other than in the course of a routine exam. Any input would be greatly appreciated!:confused:
 
Z23 concern

We are having this debate in our office. What has been said? Do we bill Z23 when doing a pediatric wellness check with vaccines? Will it pay w/o this code?
 
We are having the same debate. We pulled a sheet of the AAP website. It shows the well visit with the Z00.121 or Z00.129 on the visit and the Z23 on the shots. I feel the same way and have posted a thread earlier asking the same question. I got a reply saying that if its a well visit with a shot you code the Z00.121 as well as the Z23 to show it is part of the well visit. I spoke with someone else and they ran it through encoder pro and it is saying Z00.121 or Z00.129 on the visit and the Z23 on the shots. We are billing right now per AAP and if I get any denials then we are going to call the physician line and speak with them to get it resolved. It is very confusing...... sorry I can not be more help
 
The best reference is the ICD-10 book. Z23 can only be used for primary DX if the patient is only in the office for Vaccines. If E&M or preventive exam that DX goes primary and Z23 goes second. (technically the book only says Childhood routine exam DX is needed as primary but I believe it should be the same for all.)
 
I would say that the "Code first" instruction in ICD-10 tabular list must be followed when reporting a preventive and immunization administration at the same encounter meaning both codes are assigned with the Z00.1 code listed first. This is different from ICD-9 where code V20.2 included immunization appropriate for age as an inclusion term eliminating the need for separate ICD-9 coding for immunizations.
 
I agree with the above. If a childhood examination was done the Z00.1 category would be listed first and the Z23 for the encounter for immunization. Z23 would only be primary if the encounter was for immunization only and there was no examination.
 
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