Pediatric Coding Alert

Find out if your coding knowledge needs to get back on schedule.

Once you’ve answered the quiz questions on page 27, compare your answers with the ones provided below:

Answer 1: The answer here is pretty straightforward. “I recommend using code Z28.3 [Underimmunization status] to indicate that the child is behind and, therefore, underimmunized,” says JoAnne M. Wolf, RHIT, CPC, CEMC, coding manager at Children’s Health Network in Minneapolis.

Not sure what the most recent recommended immunization schedule is? You can find the Centers for Disease Control’s (CDC’s) 2020 recommendations, along with a catch-up schedule, at www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-combined-schedule.pdf. Just make sure that your pediatrician makes the Z28.3 determination before you code it, however.

Answer 2: Your answer to this question will depend on the nature of the patient’s illness, but you will look to codes “in the Z28.0 [Immunization not carried out because of contraindication] range, depending on what type of sickness the patient has,” says Wolf.

“Two codes that are commonly used in this situation, again depending on your pediatrician’s determination of the patient’s condition, are Z28.01 [Immunization not carried out because of acute illness of patient] and Z28.02 [… because of chronic illness or condition of patient],” suggests Donelle Holle, RN, president of Peds Coding Inc., and a healthcare, coding, and reimbursement consultant in Fort Wayne, Indiana.

Answer 3: If, on the rare occasion your pediatrician encounters an antivaxxer parent — one who objects to vaccinations on the belief that one or more of the ingredients in the vaccine has been known to cause ASD (a fact that CDC has refuted — see www.cdc.gov/ vaccinesafety/concerns/autism.html), then Holle and Wolf recommend using Z28.82 (Immunization not carried out because of caregiver refusal).

Caregiver vaccination refusal on religious grounds is a little trickier to code, however. As the caregiver, not the patient, made the decision not to immunize the child, you might be tempted to use Z28.82 in this scenario as well. However, this would be incorrect.

Instead, according to the American Academy of Pediatrics (AAP) you would use Z28.1 (Immunization not carried out because of patient decision for reasons of belief or group pressure) (See AAP Pediatric Coding Newsletter Volume 11, Issue 11 at https://coding.solutions.aap.org/article.aspx?articleid=2536853). This is because the code’s synonym — “Immunization not carried out because of religious belief” — indicates that it can be used with or without the patient’s consent.

Answer 4: The two HCPCS codes in question are G8483 (Influenza immunization was not administered for reasons documented by clinician (e.g., patient allergy or other medical reasons, patient declined or other patient reasons, vaccine not available or other system reasons)) and G8866 (Documentation of patient reason(s) for not administering or previously receiving pneumococcal vaccine (e.g., patient refusal)).

But it is unlikely you would use them in a pediatric setting because “G codes are typically only used for Medicare, though some payers will accept them,” Holle notes. “Our clinics do not utilize these codes unless instructed by a health plan for quality reporting,” adds Wolf.

This means your best bet is to “use a specific ICD-10 code when there is one,” according to Holle.

More good advice: “It is very important to use the underimmunization codes when dealing with HEDIS [the Healthcare Effectiveness Data and Information Set] to show why a vaccine was not given or why delayed,” Holle points out. Additionally, “most electronic medical records [EMRs] have standardized reports that allow patient lists to be pulled by ICD-10 code. So, if clinicians utilize these codes consistently, it makes for a simple way for a clinic to be able to identify their patient population that is underimmunized,” concludes Wolf.