Pediatric Coding Alert

Question: I know that there is a new ICD-10 code, Z71.85, that ICD-10 introduced last year for immunization counseling. Has CPT^® introduced a similar code and, if not, how would you document the service when administering a COVID-19 vaccine?

Oregon Subscriber

Answer: In October 2021, ICD-10 introduced Z71.85 (Encounter for immunization safety counseling) for “counseling of a patient or caregiver regarding the safety of a vaccine” per ICD-10 guidelines. To accompany Z71.85, you will have to look to existing CPT^® codes, as the AMA has yet to introduce a code specific to COVID-19 vaccine safety counseling.

Of those codes, 90460/+90461 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional …) will not work for two reasons.

First, ICD-10 guidelines for Z71.85 further stipulate that the code “is not for the provision of general information regarding risks and potential side effects during routine encounters for the administration of vaccines.” Generally, the counseling component associated with 90460/+90461 is of this kind.

Second, they will also not work because, unlike other vaccines, the COVID-19 vaccines carry their own administration codes specific to the drug being administered, as we reported in Pediatric Coding Alert vol. 25 no. 1. Consequently, you cannot use 90460/+90461 as the codes describe an administration service that is for other than COVID-19 vaccines.

That means you have to code the administration code appropriate to the vaccine administered (for example, 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) with the Pfizer-BioNTech vaccine code 91300 (… [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, diluent reconstituted, for intramuscular use). Like 90460/+90461, the COVID-19 vaccine administration codes include vaccine risk/benefit counseling, when performed.

For immunization safety counseling in the absence of vaccine administration, you will need to look at other current CPT^® codes. For instance, codes 99401 (Preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure); approximately 15 minutes) or 99429 (Unlisted preventive medicine service) may be appropriate, but code choice will be payer-specific. So, you should check individual payer policies before billing.