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2019 Immunization Coding for Obstetrician-Gynecologists

Coding for Vaccinations

ICD-10-CM Diagnosis Codes for Vaccination Services

The diagnosis codes for an encounter for vaccinations are found in the Z code category (Factors Influencing Health Status and Contact With Health Services) of ICD-10-CM. If a patient is being seen for a specific disease or symptom, report the code for the disease or symptom as well as a code for the vaccination.

Diagnosis codes used for vaccinations are categorized as follows:

  • Individuals with potential health hazards related to communicable diseases, including patients who have been exposed to or had contact with someone with a communicable disease
  • Encounters for inoculations and vaccinations, including prophylactic administra- tion of vaccines
  • Encounters during which a planned immunization was not carried out

The diagnosis codes most likely to be reported when vaccinations are administered to individuals with potential health hazards related to communicable diseases are listed as follows (excludes: carrier of infectious disease [Z22.-*], diagnosed current infectious or parasitic disease [Z22], and personal history of infectious and parasitic diseases [Z86.1-*]):

  • Z20 Contact with and (suspected) exposure to communicable diseases
  • Z20.1 Tuberculosis
  • Z20.3 Rabies
  • Z20.4 Rubella
  • Z20.82 Contact with and (suspected) exposure to other viral communicable diseases
  • Z20.820 Varicella
  • Z20.828 Other viral communicable diseases
  • Z20.81-* Other bacterial communicable diseases
  • Z20.811 Meningooccus
  • Z20.9 Unspecified communicable diseases
  • Z23 Encounter for immunization
  • Z51.89 Encounter for other specified aftercare (Includes: isolation)
  • Z41.8 Encounter for other procedures for purposes other than remedying health state (Includes administration of Immune sera [gamma globulin] RhoGAM, antivenin, and tetanus antitoxin)

Immunization not carried out and underimmunization status:

  • Z28 Immunization not carried out and underimmunization status
  • Z28.0 Immunization not carried out because of contraindication
  • Z28.01 Immunization not carried out because of acute illness of patient
  • Z28.02 Immunization not carried out because of chronic illness or condition of patient
  • Z28.03 Immunization not carried out because of immune-compromised state of patient
  • Z28.04 Immunization not carried out because of patient allergy to vaccine or component
  • Z28.09 Immunization not carried out because of other contraindication
  • Z28.1 Immunization not carried out because of patient decision for reasons of belief or group pressure
  • Z28.20 Immunization not carried out because of patient decision for unspecified reason
  • Z28.21 Immunization not carried out because of patient refusal
  • Z28.29 Immunization not carried out because of patient decision for other reason
  • Z28.81 Immunization not carried out due to patient having had the disease
  • Z28.82 Immunization not carried out because of caregiver refusal
    Excludes 1: Immunization not carried out because of caregiver refusal because of religious belief (Z28.1)
  • Z28.83 Immunization not carried out due to unavailability of vaccine can be reported
  • Z28.89 Immunization not carried out for other reason

Current Procedural Terminology and Medicare Coding for Vaccinations

Vaccination Procedures

A vaccination procedure has two components: 1) the administration of the vaccine and 2) the vaccine product (drug) itself. The administration may be performed by the obstetrician– gynecologist or other health care provider. When the vaccine drug and the administration are provided by the physician office, report a code for the vaccine and a code for administration of the vaccine.

Codes for Administration of the Vaccine

The administration codes specify the method and route of administration (see Table 1 for CPT codes). Medicare and CPT use the same set of codes to report administration of most vaccines.

Table 1. Current Procedural Terminology Codes for Vaccine Administration (Single or Combination Vaccine/Toxoid)

Code Method Route of Administration Type of Service  Reporting Rules

90460

Any route

Percutaneous, intradermal, subcutaneous, or intramuscular

Primary

Report for each vaccine administered. Physician also provides counseling. Patient is 18 years or younger.

90461

Any route

Percutaneous, intradermal, subcutaneous, or intramuscular

Each additional

Report for each additional component in a vaccine in conjunction with 90460. Physician also provides counseling. Patient is 18 years or younger.

90471

Injection

Percutaneous, intradermal, subcutaneous, or intramuscular

Primary

Report only one primary vaccine administration per encounter.

+90472

Injection

Percutaneous, intradermal, subcutaneous, or intramuscular

Each additional

Report for secondary or subsequent vaccine administration.
Report only with code 90460, 90471, or 90473.

90473

Intranasal

Intranasal or oral

Primary

Report only one primary vaccine administration per encounter.
Do not report 90473 with 90471.

+90474

Intranasal or oral

Intranasal or oral

Each additional

Report for secondary or subsequent vaccine administration.
Report only with code 90460, 90471, or 90473.

Current Procedural Terminology Copyright 2018 American Medical Association. All rights reserved.

Medicare requires special HCPCS codes for the administration of influenza, pneumo- coccal, or hepatitis B vaccines (see Table 2). Note that some commercial carriers also accept these HCPCS codes. A summary of these codes follows.

Table 2. Medicare’s Healthcare Common Procedure Coding System Codes for Vaccine Administration

Code Vaccine Specific Method Type of Service

G0008

Influenza

Injection

Primary

G0009

Pneumococcal

Injection

Primary

G0010

Hepatitis B

Injection

Primary

The G codes are temporary codes used to identify professional health care services that would be reported using a CPT code if one existed or to provide more information.
Report the G code for administration and the applicable CPT code for the vaccine.

There are no specific HCPCS codes for administration of other vaccines. In these cases, Medicare accepts the appropriate CPT code for the vaccine administration.

Codes for the Vaccine Drug Product

Current Procedural Terminology and Medicare use CPT codes 90476–90749 to report the vaccine drugs (see Table 3, Table 4, Table 5, Table 6, and Table 7). Beginning in 2006, CPT has included a symbol in front of a code number to indicate that this vaccine was not approved by the U.S. Food and Drug Administration at the time the CPT book was published. After the vaccine has Food and Drug Administration approval, the code is considered active. The changes in vaccine status are posted at https://www.ama-assn.org/ practice-management/find-coding-resources.

Table 3, Table 4, Table 5, Table 6, and Table 7 summarize coding for vaccines and their administration under CPT and Medicare rules, assuming that patients who are 18 years or younger are not being immunized. If patients younger than 18 years are being immunized and provided with physician counseling, then codes 90460 and 90461 would be used instead of codes 90471 and 90472 for injectable vaccines, and codes 90460 and 90461 would be used instead of codes 90473 and 90474 for intranasal or oral vaccines.

The following are administration codes:

  • 90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine/toxoid)
  • +90472 Each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure.)
  • 90473 Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine/toxoid)
  • +90474 Each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure.)
Table 3. Vaccines Commonly Administered to Adolescents and Adults (Report an Administration Code and a Vaccine Code)*
Vaccine Code for Vaccine Product Administration Codes
 CPT Medicare

Hepatitis A vaccine (HepA), adult dosage, for intra- muscular use

90632

90471–90472

90471–90472

Hepatitis A vaccine (HepA), pediatric/adolescent dosage, two-dose schedule, for intramuscular use

90633

90460–90472

90471–90472

Hepatitis A vaccine (HepA), pediatric/adolescent dosage, three-dose schedule, for intramuscular use

90634

90460–90472

90471–90472

Hepatitis B vaccine (HepB), adolescent, two-dose schedule, for intramuscular use

90743

90460–90472

G0010

Hepatitis B vaccine (HepB), pediatric/adolescent dosage, three-dose schedule, for intramuscular use

90744

90460–90472

G0010

 Hepatitis B vaccine (HepB), adult dosage, three-dose schedule, for intramuscular use

90746

90471–90472

G0010

 Hepatitis B vaccine (HepB), adult dosage, two-dose schedule, for intramuscular use

90739

90471–90472

G0010

Hepatitis B vaccine (HepB), dialysis or immuno- suppressed patient dosage, three-dose schedule, for intramuscular use

90740

90471–90472

G0010

Hepatitis B vaccine (HepB), dialysis or immuno- suppressed patient dosage, four-dose schedule, for intramuscular use

90747

90471–90472

G0010

 Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use

90636

90471–90472

90471–90472

Human papillomavirus vaccine types 6, 11, 16, 18 (quadrivalent); three-dose schedule, for intramuscular use

 90649

90460–90472

90471–90472

Human papillomavirus vaccine types 16, 18 (bivalent); three-dose schedule, for intramuscular use

90650

90460–90472

90471–90472

Human papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), two-dose or three-dose schedule, for intramuscular use

90651

90460–90472

90471–90472

Meningococcal polysaccharide vaccine, serogroups A, C, Y, W-135, quadrivalent (MPSV4), for subcutaneous use

90733

90460–90472

90471–90472

Meningococcal conjugate vaccine, serogroups A, C, Y and W-135, quadrivalent (MCV4 or MenACWY), for intramuscular use

90734

90460–90472

90471–90472

Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use

90670

90460–90472

G0009

Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use

90732

90460–90472

90471-90472

Tetanus and diphtheria toxoids adsorbed (Td), preser- vative free, when administered to individuals 7 years or older, for intramuscular use

90714

90460–90472

90471-90472

Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use

90715

90460–90472

90471-90472

Varicella virus vaccine (VAR), live, for subcutaneous use

90716

90460–90472

90460–90472

Varicella-zoster immune globulin, human, for intramuscular use

90396

90460–90472

96372

Zoster (shingles) vaccine (HZV), live, for sub- cutaneous injection

90736

90471–90472

90471–90472

Zoster (shingles) vaccine (HZV), recombinant, subunit, adjuvanted, for intramuscular use

90750

90471–90472

90471–90472

*Note: Influenza codes are outlined in Table 4. Abbreviation: CPT, Current Procedural Terminology.

Table 4. Coding for Influenza Vaccines

Vaccine (Description) Code for Vaccine Product Administration Code

Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use

90630

90460–90472

Influenza vaccine, inactivated (IIV), subunit, adjuvanted, for intramuscular use

90653

90460–90472

Influenza virus vaccine, trivalent (IIV3), split virus, preservative-free, for intradermal use

90654

90460–90472

Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use

90655

90460–90472

Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use

90656

90460–90472

Influenza virus vaccine, trivalent (IIV3), split virus,
0.25 mL dosage, for intramuscular use

90657

90460–90472

Influenza virus vaccine, trivalent (IIV3), split virus,
0.5 mL dosage, for intramuscular use

90658

90460–90472

Influenza virus vaccine, trivalent (ccIIV3), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use 

90661

90460–90472

Influenza virus vaccine (IIV), split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use

90662

90460–90472

Influenza virus vaccine, quadrivalent, live (LAIV4), for intranasal use

90672

90473–90474

Influenza virus vaccine, trivalent (RIV3), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use

90673

90460–90472

Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, preservative and antibiotic free, 0.5 mL dosage, for intramuscular use

90674

90460–90472

Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use

90682

90460–90472

Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.25 mL, for intramuscular use

90685

90460–90472

Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use

90686

90460–90472

Influenza virus vaccine, quadrivalent (IIV4), split virus,
0.25 mL dosage, for intramuscular use

90687

90460–90472

Influenza virus vaccine, quadrivalent (IIV4), inactivated, adjuvanted, preservative free, 0.25 mL dosage, for intramuscular use

90689

90460–90472

Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use

90756

90460–90472

 

Table 5. Medicare Coding for Influenza Vaccines

Vaccine Code for Vaccine Product Administration Code (CPT and Medicare)

Influenza virus vaccine, split virus, for intramuscular use (Agriflu)

Q2034

G0008

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Afluria)

Q2035

G0008

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Flulaval)

Q2036

G0008

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluvirin)

Q2037

G0008

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Fluzone)

Q2038

G0008

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (Not Otherwise Specified)

Q2039

G0008

 

Table 6. Vaccines Commonly Administered to Children (Report an Administration Code and a Vaccine Code)*

Vaccine Code for Vaccine Product Administration Code (CPT and Medicare)

Diphtheria and tetanus toxoids and acellular pertussis vaccine and inactivated poliovirus vaccine (DTaP-IPV), when administered to children 4 through 6 years of age, for intramuscular use

90696

90460–90472

Diphtheria and tetanus toxoids and acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenzae b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use

90697

90460–90472

Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP-IPV/Hib), for intramuscular use

90698

90460–90472

Diphtheria, tetanus toxoids, acellular pertussis vaccine, hepatitis B, and inactivated poliovirus vaccine (DTaP-HepB-IPV), for intra- muscular use

90723

90460–90472

Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intra- muscular use

90700

90460–90472

Diphtheria and tetanus toxoids adsorbed (DT) when administered to individuals younger than 7 years, for intramuscular use

90702

90460-90472

Hepatitis B and Haemophilus influenzae type b vaccine (Hib-HepB), for intramuscular use

90748

90460–90472

Haemophilus influenzae type b vaccine (Hib), PRP-OMP conjugate, three-dose schedule, for intramuscular use

90647

90460–90472

Haemophilus influenzae type b vaccine (Hib), PRP-T conjugate, four- dose schedule, for intramuscular use

90648

90460–90472

Measles–mumps–rubella virus vaccine (MMR), live, for sub- cutaneous use

90707

90471–90472

 Measles–mumps–rubella and varicella vaccine (MMRV), live, for subcutaneous use

90710

90460–90472

Poliovirus vaccine, inactivate (IPV), for subcutaneous or intramuscular use

90713

90460–90472

Rotavirus vaccine, pentavalent (RV5), three-dose schedule, live, for oral use

90680

90460–90461

Varicella virus vaccine (VAR), live, for subcutaneous use

90716

90460–90472

Abbreviation: CPT, Current Procedural Terminology.
*Note: Influenza codes are outlined in Table 4.

Table 7. Vaccines Commonly Administered for Travel (Report an Administration Code and a Vaccine Code)

 

Vaccine Code for Vaccine Product Administration Code

Rabies vaccine, for intramuscular use

90675

90460–90472

Typhoid vaccine, live, oral

90690

90460–90461

Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use

90691

90460–90472

Yellow fever vaccine, live, for subcutaneous use

90717

90460–90472