It is that time of year again for back-to-school shopping for new clothes, backpacks, sneakers and immunizations. Though they’re an unconventional item on your supply list, immunizations are an important item to check off.
Immunizations aren’t only for babies and young children; preteens and teens also need them in order to stay healthy during the school year. By not getting vaccinated, children are at increased risk for diseases that could also spread to others in the classrooms and community.
Whether we realize it or not, disease outbreaks still happen. According to the National Center for Immunizations and Respiratory Diseases, Office of Health Communication Service, in 2014 the reported number of cases of measles was 668 cases from 27 states. This is the greatest number of cases since the elimination of measles was documented in the U.S. in 2000. From January 2 to July 22, 2016, there were 48 cases of measles reported in the United States. And just last year, from January to June, almost 6,000 cases of whooping cough were reported across all 50 states and Puerto Rico.
Making sure your patients are up-to-date with their vaccinations is one way to help protect the communities and schools from various outbreaks that could possibly cause unnecessary illness and death. Educating your patients about the importance of getting every recommended dose of each vaccine will provide your patients with the best protection possible.
During the well-child encounter, vaccines are provided and the ICD-10 directs us to code Z00.121 and Z00.129 (routine health check for a child over 298 days old). This includes immunizations appropriate to the patient’s age. Z23 can be used as the secondary code if the vaccines were given as part of the preventive health care services (well-child visit). ICD-10 requires only one code (Z23) per vaccination, regardless of single or combination. Report Z23 for all vaccination diagnoses.
If the E/M Code – patient encounter other than preventive service is provided the same day as a prophylactic immunization, modifier 25 may need to be appended to the E/M code to indicate that the visit was significant and separately identifiable from physician’s vaccine counseling/administration.
Example: A patient present for a visit to evaluate the control of his/her diabetes and at the same visit receives an influenza vaccine administration. A physician might report code 99213-25 with diagnosis code E11.9 in addition to the appropriate flu vaccine and administration codes.
Vaccine administration services notes:
- Only one initial administration code can be reported per day, regardless of vaccine administration method.
- CPT codes 90460 (18 years and younger), 90471 and 90473 are initial administration codes and cannot be billed together on the same date of service.
- When one of these initial administration codes is billed, report all additional vaccine/toxoid components administered with the appropriate add-on code (i.e. 90461, 90472 or 90474). Reference your CPT book for coding guidelines if you have additional questions.