Pediatric Coding Alert

Question: A young patient came to us after being bitten by a squirrel. Though the patient was asymptomatic, our pediatrician decided to vaccinate against rabies. Should I use Z23 as the primary code with Z20.3 as a secondary, or would Z20.3 on its own be the right way to go?

Codify Subscriber

Answer: The answer here will probably depend on the reason for the vaccination. At least one private payer, BlueCross BlueShield (BCBS) of North Carolina, for example, uses Z23 (Encounter for immunization) when 90675 (Rabies vaccine, for intramuscular use) or 90676 (Rabies vaccine, for intradermal use) are used for prophylactic purposes. However, in exposure scenarios such as this, BCBS North Carolina prefers Z20.3 (Contact with and (suspected) exposure to rabies) to be linked with 90675, 90676, 90375 (Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use) or 90376 (Rabies immune globulin, heat-treated (RIg-HT), human, for intramuscular and/or subcutaneous use) (Source:  www.bluecrossnc.com/sites/default/files/document/attachment/services/public/pdfs/medicalpolicy/immunization_guidelines.pdf).

Consequently, in your situation, Z20.3 more accurately describes the context for the vaccination. However, this is another one of those moments where you should contact your payer to determine exactly which diagnosis code they prefer in encounters such as these.