Pediatric Coding Alert

Question: Should I use individual diagnosis codes for each vaccination, or should I lump them all under the V20.2 (routine infant or child health check) diagnosis code?

California Subscriber

Answer: Use the appropriate ICD-9 code for the specific immunization, just as you use the appropriate CPT code for each even if given during a well visit.
 
For example, a baby comes in for a one-year well visit and the pediatrician decides that because of an ear infection, the immunizations will not be given. Code the well visit and link V20.2 to it. The mother brings the baby back for an ear recheck 10 days later, and after making sure recovery has occurred, the pediatrician asks the nurse to administer the one-year vaccinations. Code 99212 (established patient office or other outpatient visit) for the recheck, with the appropriate otitis media diagnosis code (381-382) and V67.9 (unspecified follow-up examination) to show recovery has occurred. The one-year immunizations are multiple. CPT codes with linked ICD-9 codes include the following:

90471 immunization administration (includes percutaneous, intradermal, subcutaneous, intramuscular and jet injections); one vaccine (single or combination vaccine/toxoid) with V20.2

90472 each additional vaccine (single or combination vaccine/toxoid) (list separately in addition to code for primary procedure) (4 units) with V20.2

90669 pneumococcal conjugate vaccine, polyvalent, for children under five years, for intramuscular use with V03.82 need for prophylactic vaccination and inoculation against bacterial diseases; streptococcus pneumoniae (pneumococcus)

90707 measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous or jet injection use with V06.4 measles-mumps-rubella (MMR)

90713 poliovirus vaccine, inactivated, (IPV), for subcutaneous use with V04.0 need for prophylactic vaccination and inoculation against certain viral diseases; poliomyelitis

90716 varicella virus vaccine, live, for subcutaneous use with V05.4 need for other prophylactic vaccination and inoculation against single diseases; varicella

90748 hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use with V06.8 need for prophylactic vaccination and inoculation against combinations of diseases; other combinations.

Link the appropriate diagnosis codes to the CPT codes for the vaccinations, and don't forget the administration code.
 
For the same well visit, if the immunizations are administered at the same time, code the well visit 99392, linked to V20.2. Then code the individual immunizations with their respective diagnosis codes linked, as above.
 
The ramifications of coding individual vaccination diagnosis codes are immediately clear if you file on paper: You will need an extra HCFA 1500 claim form, as only four diagnoses are allowed on each. This is not a problem with electronic filing. 
 
Although it is not necessary to use individual diagnosis codes, it is the most accurate and specific way. If an insurance company questions what you did during that visit, the correct diagnosis will help you. V20.2 is for the examination, not the immunizations. It's important to document your value as a pediatrician by indicating the different diagnoses for each vaccination; it's also proper coding.
 
Answers to Reader Questions and You Be the Coder reviewed by Richard H. Tuck, MD, FAAP, founding chairman, AAP coding and reimbursement committee, PrimeCare Pediatrics in Zanesville, Ohio; and Thomas A. Kent, CPC, CMM, president, Kent Medical Management in Dunkirk, Md.