Pediatric Coding Alert

Narrow down your choices and pick the right code for the right patient.

On November 2, 2021, following the Food and Drug Administration’s (FDA’s) authorization of the Pfizer COVID-19 vaccine for children between the ages of 5-17, the Centers for Disease Control and Prevention (CDC) announced that children in that age group could now go ahead and be vaccinated.

At the time of going to press, the “CDC recommends everyone age 5 and older get a COVID-19 vaccine to help protect against COVID-19” (Source: www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/children-teens.html).That means you should now become comfortable reporting the appropriate vaccine and administration codes involved.

So, here’s everything you need to know.

1. Know Which Patients are Eligible

Current CDC recommendations are that only the Pfizer-BioNTech vaccines be administered to children between the ages of 5-17. Your pediatrician should only administer the Moderna vaccine and the single-dose Johnson & Johnson vaccines to patients 18 years and older at this time.

2. Know the Difference Between the 2 Pfizer-BioNTech Vaccines

Pfizer has developed two vaccines that feature different buffers: a phosphate buffered saline (PBS) formula, and a new, tris-sucrose buffer formula. The American Academy of Pediatrics reports that the tris-sucrose should be used for children aged 5-11, and the PBS formula be used for children 12 years and up (Source: www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/covid-19-vaccine-for-children/about-the-covid-19-vaccine-frequently-asked-questions/).

Authorization alert 1: At the time of going to press, the FDA has given the Pfizer-BioNTech tris-sucrose formulation emergency use authorization (EUA) but not full FDA authorization.

3. Know the Difference Between an Additional Dose and a Booster and Who Is Eligible

In addition to administering two doses of the Pfizer and Moderna vaccines and single doses of the Johnson & Johnson vaccine, the CDC is now recommending third doses and booster shots for certain patients.

Additional doses should be given to patients for whom the initial immune response following a primary COVID-19 vaccine series is likely to be insufficient, such as patients who have:

• Been receiving active cancer treatment for tumors or cancers of the blood
• Received an organ transplant and are taking medicine to suppress the immune system
• Received a stem cell transplant within the last two years or are taking medicine to suppress the immune system
• Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
• Advanced or untreated HIV infection
• Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response (Source: www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/immuno.html).

Booster doses should be given to patients who have received the initial one- or two-dose COVID-19 vaccines but who need another shot to strengthen their immune response, which has waned over time, such as patients who are:

• People 65 years and older, 50-64 years with underlying medical conditions, or 18 years and older who live in long-term care settings should receive a booster shot.
• People 18 years and older should receive a booster shot at least two months after receiving their Johnson & Johnson/Janssen COVID-19 vaccine (Source: www.cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html).

4. Know How to Code the Different Vaccines and Doses

Pfizer-Biontech vaccine: Use vaccine code 91300 (… COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use) with the appropriate vaccine administration code:

• 0001A (Immunization administration by intramuscular injection of … COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted; first dose)
• 0002A (… second dose)
• 0003A (… third dose)
• 0004A (… booster dose).

Pfizer-Biontech tris-sucrose vaccine: Use vaccine code 91305 (… COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use) with the appropriate vaccine administration code:

• 0051A (Immunization administration by intramuscular injection of … COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; first dose)
• 0052A (… second dose)
• 0053A (… third dose)
• 0054A (… booster dose).

Moderna vaccine: For first, second, and third doses, use vaccine code 91301 (… COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage, for intramuscular use) with the appropriate vaccine administration code:

• 0011A (Immunization administration by intramuscular injection of … COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; first dose)
• 0012A (… second dose)
• 0013A (… third dose).

Then, for booster doses, use vaccine code 91306 (… COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use) with administration code 0064A (… 50 mcg/0.25 mL dosage; booster dose).

Authorization alert 2: At the time of going to press, the Moderna booster — 91306 — is awaiting both EUA and full FDA authorization.

Johnson & Johnson single-dose vaccine: Use vaccination code 91303 (… COVID-19 vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x10¹⁰ viral particles/0.5mL dosage, for intramuscular use) with the appropriate vaccine administration code:

• 0031A (Immunization administration by intramuscular injection of … COVID-19 vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5 mL dosage; single dose)
• 0034A (… booster dose).

For more information: Consult the September Update of CPT^® Assistant by going to www.ama-assn.org/system/files/cpt-assistant-guide-coronavirus-september-2021.pdf.