Immunizations are recommended as part of comprehensive care for women. Under the Patient Protection and Affordable Care Act (ACA), vaccines recommended by the Advisory Committee on Immunization Practices are required to be provided with no cost sharing (ie, no co-pay) for children, adolescents, and adults. Check the list of vaccines covered (https://www.healthcare.gov/coverage/preventive-care-benefits/) for more information about the ACA. The American College of Obstetricians and Gynecologists (ACOG) and its Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group recognized a need for a coding guide solely focused on immunization. Correct coding helps ensure that a practice receives payment for the vaccines given to patients. Proper coding means being sure that the code selected from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) is appropriate as follows:
- The code represents the most accurate description of “what” was performed and “why” it was performed consistent with coding conventions and guidelines.
- The code is supported by documentation in the medical record.
The Current Procedural Terminology (CPT) coding guidelines state that the code selected must be the most accurate description of the service provided and be consistent with coding conventions and guidelines. Individuals responsible for coding should carefully review their coding books, including any coding guidelines, notes, instructions, or other explanatory statements. These may be printed under subsections, headings, sub- headings, or before and after codes. The physician also should understand the bundling and unbundling rules used by CPT, commercial payers, and the Centers for Medicare & Medicaid Services. It is vital that coding reference materials be kept up to date. Coding guidelines change, and new codes are implemented every year. Medicare bundling rules, however, are revised every quarter. Failure to keep your coding knowledge up to date can result in improper billing and missed reimbursement opportunities.
All diagnosis codes referred to in Immunization Coding for Obstetrician–Gynecologists were excerpted from the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), October 2018 revision, published by the United States Government under the auspices of the ICD-10-CM Coordination and Maintenance Committee.
Current Procedural Terminology (CPT) copyright 2018 American Medical Association (AMA). All rights reserved. Fee schedules, relative value units, conversion factors, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. Applicable FARS/DFARS restrictions apply to government use. CPT is a registered trademark of the American Medical Association.
This book is provided by the American College of Obstetricians and Gynecologists (ACOG) for educational purposes only. It is not intended to represent the only, or necessarily the best, coding format or method for the situations discussed, but rather as an approach, view, statement, or opinion that may be helpful to individuals responsible for diagnosis and procedure coding. The statements made in this publication should not be construed as ACOG policy or procedure, nor as standards of care. The American College of Obstetricians and Gynecologists makes no representations or warranties, expressed or implied, regarding the accuracy of the information contained in this book and disclaims any liability or responsibility for any consequences resulting from or otherwise related to any use of, or reliance on, this book. Please reference the CPT manual for complete procedure code descriptions along with additional CPT coding instructions and guidelines.
Immunization Coding for Obstetrician–Gynecologists 2019 was developed by ACOG’s Immunization, Infec- tious Disease, and Public Health Preparedness Expert Work Group and ACOG’s Coding Department with special contributions by the following:
Laura E. Riley, MD, Chair, ACOG Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group
J. Martin Tucker, MD, ACOG Committee on Heath Economics and Coding Ex Officio member and ACOG Immunization, Infectious Disease, and Public Health Preparedness Expert Work Group member
ACOG Practice Activities Division Staff: Christopher Zahn, MD Col (Ret), USAF, MC Sarah Carroll, MPH
Debra Hawks, MPH Lindsey Regallis
ACOG Health Economics Department Coding Staff: Miroslava Rudneva, RHIT, CPC
Donna Tyler, CPC, COBGC
Copyright 2019 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permis- sion from the publisher.
Requests for authorization to make photocopies should be directed to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400.
American College of Obstetricians and Gynecologists
409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920
Suggestions and comments are welcome. Address your comments to the following: American College of Obstetricians and Gynecologists
Division of Practice Activities—Immunization Program 409 12th Street, SW, PO Box 96920
Washington, DC 20090-6920
Telephone (202) 863-2498
Fax: (202) 484-3993