Health Information Management

Coding for vaccinations during National Immunization Awareness Month

Coding Educator, August 1, 2008

by Shannon McCall, RHIA, CCS, CPC-I
 
Children do not come with instruction manuals, but there are many books available to help us along the way. Those books, and our pediatricians, recommend that we child-proof our homes and surroundings with all kinds of gadgets such as safety locks, outlet covers, and bike helmets. They give us all kinds of instructions about how long to use a car seat, which way to lay babies down to sleep, and what to give them to eat. They also tell us to protect our children from preventable diseases with vaccinations.
 
August is National Immunization Awareness Month. Vaccines assist in safeguarding children from developing potentially deadly diseases. However, controversy has erupted recently over whether there is a link between potentially harmful substances in vaccines (such as mercury) and diseases (such as autism).
 
One of the newest Food and Drug Administration (FDA) approved vaccinations is for prevention of the human papillomavirus (HPV). The FDA approved Gardasil® on June 8, 2006 which meant CPT code 90649 was no longer “pending FDA approval” in the 2007 CPT manual. HPV is a sexually-transmitted disease which has been directly linked to cervical cancer. Gardasil’s® tag line is “I want to be one less,” which I think should be the mantra for all diseases that we vaccinate against. No parent wants their child to suffer from a bruised elbow, much less a potentially deadly disease. 
 
So what can we expect in the future? The ICD-9-CM Coordination and Maintenance Committee, which met March 19-20, 2008, proposed new V codes for under-immunized and lapsed immunization statuses. Unfortunately, there was not enough evidence to support adding the code set for fiscal year (FY) 2009. But, rest assured, you might see it as an addition for FY 2010. Currently, the ICD-9-CM manual contains V codes (category V64.0x) for why an immunization was not carried out (e.g., caregiver refusal, religious reasons) but not to identify a patient who is currently under-immunized or has had a lapse.
 
Scientists work diligently to come up with new vaccines every day, but it is a long process to obtain FDA approval. Some vaccines are already pending FDA approval such as the vaccine for pandemic flu (CPT code 90663). Other changes you should expect in the future are the administration of more oral vaccines. There are limited licensed oral vaccines on the market today, but given the fear injections instill in patients, I hope to see more in the future.
 
Here are a few quick tips for coding immunizations:
  • Don’t forget that CPT codes 90476-90749 are for the supply of the product only. Report a separate code for the administration of the immunization (CPT codes 90465-90474)
  • Use combination codes for vaccines (if a code exists) rather than assigning for each individual vaccine (e.g. CPT code 90701)
  • If a separately identifiable evaluation and management (E/M) service is provided, report the E/M code in addition to the vaccine administration codes with modifier -25.
As we celebrate National Immunization Awareness month, keep in mind that prevention of disease is the first step towards eradication. I hope all our readers and their families stay happy and healthy! 

Editor's note: Shannon McCall, RHIA, CCS, CPC-I, is the director of coding and HIM for HCPro, Inc., in Chesterfield, VA. You can e-mail her at smccall@hcpro.com.

Most Popular