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)

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

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 5. Medicare Coding for Influenza Vaccines

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

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