With flu season just around the corner, and no end to the pandemic in site, this installment of “Spotlight on CPT” reviews and updates previous information provided 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 three 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. The third set of administration codes are related to COVID immunizations. These are identified by dose (first, second, single) and manufacturer. A new CPT appendix, Appendix Q, was created to help coding professionals align the administration and vaccine codes for COVID vaccinations.
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 two specific scenarios 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.
A 48 year-old male goes to a local pharmacy to get his second in the series of Pfizer vaccines against COVID-19. By utilizing the Appendix Q table, we can see that the administration code for this vaccine will be 0002A for the second dose of the Pfizer COVID vaccine, and 91300 is the code that should be assigned for the vaccine itself.
Now, light has been shed on coding for vaccinations.
About the Author
Dianna Foley, RHIA, CCS, CHPS, CDIP is
OHIMA's Education Coordinator. Dianna has been an HIM
professional for over 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She previously 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 and holds RHIA, CHPS, CDIP and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and is a presenter on coding topics at the national, state, and regional levels. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
