Ob-Gyn Coding Alert
Make Sense of Immunization Diagnoses
Question: I’m a bit puzzled with Immunization diagnoses. Prior to ICD-10, we used V04.89, V06.1, V05.3 and V04.81 for our Tdap, Flu, Hep and Gardasil vaccines. According to ICD-10, we can never use Z23 alone and refers us to use a procedure code. I’m not sure what those would be. I’ve been researching all over, but I can’t get a specific response. Can you clarify this for me?
Georgia Subscriber
Answer: The procedure is the injection that includes what you gave: a CPT® code for the vaccine or perhaps a J code for the drug product plus the injection code. So a Depo shot would be J1050 (Injection, medroxyprogesterone acetate, 1 mg) for the drug product, and 96372 (Therapeutic, prophylactic, or diagnostic injection [specify substance or drug]; subcutaneous or intramuscular) for the injection procedure linked to Z23 (Encounter for immunization).
The HPV vaccine would be 90649 (Human Papillomavirus vaccine, types 6, 11, 16, 18, quadrivalent [4vHPV], 3 dose schedule, for intramuscular use) or 90650 (Human Papillomavirus vaccine, types 16, 18, bivalent [2vHPV], 3 dose schedule, for intramuscular use) for the vaccine and 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; 1 vaccine [single or combination vaccine/toxoid]) for the injection procedure linked to Z23.
Heads up: On October 1, 2016, you may see the addition of diagnostic codes for specific vaccinations to ICD-10. These additions have been requested by the Centers for Disease Control (CDC) in order to track this information, but until then, you can only report the code Z23 if the sole purpose of the encounter was for vaccination. Code Z23 would be linked only to the vaccination drug and procedure codes in that case, and if a separate E/M service was performed and documented on that date of service, you would link a different diagnosis code to the visit.
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