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Vaccination Coding Guide

The Vaccination Coding Guide outlines the essential components for coding vaccination services, including vaccine/toxoid CPT codes, administration CPT codes, and ICD-10-CM diagnosis codes. It provides specific CPT codes for various vaccines and administration methods, along with billing tips for accurate coding. Additionally, it emphasizes the importance of using the Z23 code for immunization encounters and details Medicare and HCPCS codes for certain vaccines.

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71 views5 pages

Vaccination Coding Guide

The Vaccination Coding Guide outlines the essential components for coding vaccination services, including vaccine/toxoid CPT codes, administration CPT codes, and ICD-10-CM diagnosis codes. It provides specific CPT codes for various vaccines and administration methods, along with billing tips for accurate coding. Additionally, it emphasizes the importance of using the Z23 code for immunization encounters and details Medicare and HCPCS codes for certain vaccines.

Uploaded by

deba8288
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PDF, TXT or read online on Scribd
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Vaccination Coding Guide

1. Key Components of Vaccine Coding


To properly code vaccination services, you need three components:

Component Description Examples

1. Vaccine/toxoid CPT code The product itself (the 90686 – Flu vaccine
vaccine)

2. Administration CPT code The service of 90471 – Admin 1st vaccine


administering the vaccine

3. ICD-10-CM diagnosis The reason (indication) for Z23 – Encounter for


code vaccination immunization

2. CPT® Codes for Vaccine Products (Drugs)


These codes vary based on age group, vaccine type, and route of administration.

Common Vaccine Product Codes:

Vaccine CPT Code

Influenza (flu) 90686

COVID-19 91300–91318

Tdap 90715

Hepatitis B 90744

MMR 90707

Varicella (chickenpox) 90716

HPV (Gardasil 9) 90651

3. CPT® Codes for Vaccine Administration


CPT Code Description

90460 Admin of first vaccine, with counseling, per


antigen (age 0–18)

90461 Each additional antigen (use with 90460)

90471 Admin of 1st vaccine (no counseling, any


age)

90472 Admin of each additional vaccine

90473 Admin of 1st intranasal/oral vaccine

90474 Each additional intranasal/oral vaccine

4. ICD-10-CM Code
Always assign Z23 for immunization:

• - Z23 – Encounter for immunization

You can assign this along with other diagnosis codes, if applicable.

5. Medicare and HCPCS Codes


Some vaccines have HCPCS Level II codes, especially for Medicare billing:

Vaccine HCPCS Code

Influenza (Flu) Q2034–Q2039, G0008 (admin)

Pneumococcal G0009 (admin)

COVID-19 M0201 (admin @ home), 91300–91318

6. Billing Tips
• Bill each component separately: product + admin + diagnosis.
• If multiple vaccines are given, use add-on admin codes (e.g., 90472).
• Use modifier -25 on E/M code if done same day with significant, separately identifiable
service.

7. Example Scenario
Case: A 5-year-old receives MMR and Varicella vaccines with counseling.

Codes:

• - Product: 90707 (MMR), 90716 (Varicella)


• - Admin: 90460 x2 (for MMR & Varicella – each single-antigen vaccine, with counseling)
• - ICD-10: Z23
✅ Summary Checklist
Step Code Type Example

1 Vaccine product code 90686

2 Administration code 90471

3 Diagnosis code Z23

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