Pediatric Coding Alert

Question: The day after a patient received vaccine shots, the mother brought the girl back in for a huge knot in her leg at the injection site. Should I charge for this visit?

Indiana Subscriber

Answer: Yes, you should report the visit with the appropriate-level office visit code (9921x, Office or other outpatient visit for the evaluation and management of an established patient ...). Consider a few possibilities for the ICD-9 code.

If the knot was due to an adverse effect or allergic reaction to a properly administered product, use 995.2x (Other and unspecified adverse effect of drug, medicinal and biological substance). Check out ICD-9s Table of Drugs and Chemicals for E codes that indicate the specific substance that caused the injury. If the substance is specified, you would use a fifth digit of 9 for other drug, medicinal and biological substance. For instance, an adverse effect to the measles vaccine correctly administered for therapeutic use falls under E949.4 (Drugs, medicinal and biological substances causing adverse effects in therapeutic use; other vaccines and biological substances; measles vaccine), which you would list after 995.29. If the drug is not specified in the table, use a fifth digit of 0: 995.20.

If the knot is due to a vaccination complication not elsewhere classified, consider a different injury subcategory. Looking up Complications, vaccination in ICD-9s Alphabetic list contains other options including:

" Vaccination -- 999.9 (Other and unspecified complications of medical care, not elsewhere classified)

" Reaction (allergic) or serum -- 999.5 (Other serum reaction).