Pediatric Coding Alert

Check out which existing admin code survived the cut

To streamline reporting, CPT^® has created new codes that effectively consolidate the over 50 previous COVID-19 immunization codes. CPT^® will also delete all previously approved COVID-19 vaccine product and vaccine administration codes, with the exception of product code 91304 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, recombinant spike protein nanoparticle, saponin-based adjuvant, 5 mcg/0.5 mL dosage, for intramuscular use) from the code set effective Nov. 1, 2023.

Background: The Food and Drug Administration (FDA) recently recommended a shift to a monovalent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease 2019 [COVID-19]) vaccine that targets the predominant XBB lineage virus strain for the 2023-2024 vaccine administration season. As a response, CPT^® approved new monovalent COVID-19 vaccine product codes for Pfizer and Moderna vaccines which are currently waiting for FDA approval. CPT^® also approved a new administration code for use with any COVID-19 vaccine for all age-ranges, which will replace all previous specific vaccine administration codes.

Here’s what you need to know to code your pediatrician’s COVID vaccine services as we move into the winter season.

Meet The New Codes

Pfizer: The following codes have been approved for Pfizer’s new monovalent vaccine products:

• 91318 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, 3 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use) – 6 months through 4 years
• 91319 (… 10 mcg/0.2 mL dosage, tris-sucrose formulation…) – 5 years through 11 years
• 91320 (… 30 mcg/0.3 mL dosage, tris-sucrose formulation…) – 12 years and older

Moderna: The following codes have been approved for Moderna’s new monovalent vaccine products:

• 91321 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, 25 mcg/0.25 mL dosage, for intramuscular use) – 6 months through 11 years
• 91322 (… 50 mcg/0.5 mL dosage…) – 12 years and older

Administration: The following code is to be used with all COVID-19 vaccine product codes:

• 90480 (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, single dose)

Like the previous vaccine administration codes, counseling is bundled with 90480, so be sure to not report that as a separate service.

Remember: This administration code is for COVID-vaccines only. Do not report 90480 in conjunction with non-COVID products.

Say Goodbye to All But One Previous Admin Code

As previously mentioned, CPT^® is deleting all previously approved COVID-19 vaccine product and vaccine administration codes, effective Nov. 1, 2023. The one exception is 91304, which represents the Novavax vaccine product, which will continue to be available for use. While administration codes for the Novavax product are slated for deletion, you will need to continue to use them until 90480 becomes effective. That will happen when the FDA approves the new product codes. Once effective, it should be the only admin code used for the administration of that vaccine.

Note: CPT^® revised the parenthetical note for code 91304 to reflect this change.

Start Ignoring Appendix Q

Because of this code consolidation, Appendix Q, which was created to house the specific codes for COVID-19 vaccines, is also queued up for deletion on Nov. 1, 2023.

To assist CPT^® code users in differentiating and reporting the available vaccine product codes and the associated immunization administration codes appropriately, the AMA established a website (https://www.ama-assn.org/practice-management/cpt/ covid-19-cpt-coding-and-guidance) that features timely updates.

This development is likely to bring a sigh of relief to coders. The pandemic led to the creation of many new codes and frequent updates that made keeping up to date a challenge. “Halleluiah!” exclaimed Jan Blanchard, CPC, CPEDC, CPMA, pediatric solutions consultant at Physician’s Computer Company in Winooski, Vermont. “The burden of frequent code changes due to the rapid development of more vaccines, as well as the use of manufacturer-specific codes, complicated vaccine administration and billing operations at the worst possible time. This simplification comes as relief during some of the busiest, leanest times in the 30 years I have been doing this work.”

Note: The CPT^® panel decided to delete these codes after the finalization of the CPT^® 2024 codebook. Therefore, all of the deleted codes, including Appendix Q, will appear in your copy of CPT^® 2024, per CPT^® Assistant August Update (Number 8, 2023). This is why it’s particularly important to refer to the AMA site to reference the most up-to-date information.

Gain More Insight Into Why This is Happening

The Vaccines and Related Biological Products Advisory Committee (VRBPAC), an advisory group of the FDA, recommended that in light of the expiration of the public health emergency (PHE) in May 2023, there is no longer a need for the extensive granularity of the previously approved vaccine and administration codes. Therefore, CPT® will switch to annual COVID-19 vaccine updates, similar to their updates for influenza vaccinations. The VRBPAC met recently to discuss which strain(s) of the COVID-19 virus should be included in a vaccine for the 2023-2024 vaccination season and recommended that the COVID-19 vaccine for the 2023-2024 vaccination season be a monovalent vaccine that contains the XBB.1.5 strain.

Read more: Find more guidance from the Centers for Disease Control and Prevention (CDC) regarding which patients should receive a COVID-19 vaccine here: www.cdc.gov/ coronavirus/2019-ncov/vaccines/different-vaccines/overview- COVID-19-vaccines.html.