Tuesday, January 21, 2020

Coding Vaccinations

With flu season upon us, this installment of “Spotlight on CPT” presents information on coding for vaccinations.

Coding professionals who assign CPT codes for vaccinations must be aware that two codes will be needed in order to capture the entirety of the procedure; one code is for the administration of the vaccine (the actual injection itself), and the second code is for the vaccine or toxoid that is being given.  Let’s talk about the administration codes first.

CPT codes for the administration of a vaccine are broken down into two distinct groups.  The first group of codes (90460-90461) require that the physician or qualified healthcare professional provide counseling regarding the component(s) of the vaccine to the patient.  For this code group, the age of the patient is a factor with the age being through 18 years.  The second group of codes (90471-90474) are to be used when there is no counseling performed.  The breakdown of these codes is by the route of administration: either percutaneous, intradermal, subcutaneous, or intramuscular injection or via intranasal or oral route.  There is an add-on code for each of the base codes to identify any additional vaccines that may be administered.

Once the appropriate administration code has been chosen, the coding professional will need to determine the appropriate vaccine or toxoid code that should also be assigned.  In this coding step, it is important that the precise code for the vaccine/toxoid is assigned.  Different CPT codes exist for vaccines that have variations in chemical formulation (influenza vaccines for example), dosage (hepatitis A-adult vs. pediatric dosage for example), or route of administration (rabies-intradermal vs. intramuscular for example).

When assigning the vaccine/toxoid code, coding professionals should be aware that there are combination codes available.  Like with all other combination code guidelines, it is inappropriate to separately code for the individual components of a vaccine if a combination code exists.  For example, if an adult patient was to receive an intramuscular Hib-HepB vaccine, the appropriate code is 90478 and not 90739 and 90647.

As previously mentioned, it is important to assign the precise vaccine/toxoid code.  Should a coding professional encounter a vaccine that does not have a specific CPT code, an unlisted code (90479) should be reported instead.  Also, be aware that the coding for immune globulins does not fall into any of the previously mentioned categories of codes.  Instead, those codes are in the ranges of 90281-90399 (immune globulin) and 96365-96375 (administration).

Let’s look at a specific scenario in order to apply the concepts noted above.  A 60 year-old female goes to a local pharmacy to get a Shingrix vaccine.  The pharmacist administers the vaccine intramuscularly in the left shoulder and provides information on possible side effects.  The CPT codes to assign are 90471 for the administration and 90750 for the Zoster vaccine.

Now, light has been shed on coding for vaccinations.

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.