Four Suggestions for Pediatric Practices to Code Immunizations
Immunizations are an important aspect of all pediatric groups. Whether it’s during the flu season or year-round, having an a way of coding immunizations that increases efficiency in your practice is never a bad thing. Four suggestions related to coding immunizations include:
- Select the Proper CPT Code for the Vaccine. There are a range of CPT codes that align to the different immunizations provided. For example, Gardasil 9 has the CPT code 90651 while Prevnar 13 is 90670. A solid pediatric EHR system should have a vaccine inventory management system that helps align the proper CPT code to the actual vaccine given. Patients that receive a VFC vaccine (no cost to the practice) should, in most cases, bill for this CPT code since many managed Medicaid plans pay the vaccine admin code on the vaccine.
- Add ICD10 Code Z23 as Part of the Visit. Z23 should appear as the diagnosis code with the CPT code for the vaccine. Z23 is an encounter for immunization. While other diagnosis codes will also be present for well visits or sick visits, Z23 should also be added to the visit when a vaccine is given.
- Use the Correct Administration Code if the Provider Performed Counseling. If the Pediatrician (or NP or PA) provided the counseling associated with the vaccine then the admin codes to use for patients under 18 are 90460/90461 while patients over 18 are 90471/90472. If the pediatrician did not provide counseling (counseling and admin by MA/Nurse), then 90471/90472 should be used for all patients regardless of age.
- Insure the Correct Components are Billed Related to Vaccine Admin Codes 90460 and 90461. The vaccine admin codes 90460 and 90461 are used when a pediatrician (or NP/PA) performs counseling for patients less than 18 years of age. If a vaccine has only component, 90460 should be used. If the vaccine has three components (e.g. MMR) then the coding should reflect the proper units with 90461. As an example, MMR would be 90460, 90461 (2 units).
An integrated pediatric EHR and revenue cycle management system should integrate these rules in a manner that captures the CPT codes, admin codes, and ICD10 codes in a consistent manner as the practice operates. All in all, a good design helps reduce the administration burden of extra data entry while capturing the data for multiple uses including sending to state immunization registries as well as for the revenue cycle management team.