Primary Care Coding Alert

Learn how to document the new vaccine, additional doses, and boosters.

If your head is spinning over the recent flurry of activity on the COVID-19 vaccine front, you’re not alone. Keeping track of the Food and Drug Administration’s (FDA’s) Emergency Use Authorization approval (EUA) of the different vaccines has almost become a full-time job in itself.

So, we’ve put together these answers to all your frequently asked COVID vaccine questions, including questions about the new additional dose and booster dose administration codes along with their corresponding vaccine codes. We’ve also added information about the codes for the new Pfizer-BioNTech tris-sucrose vaccine and its administration.

But before we get there, we need to ask the following question:

Is There a Difference Between an Additional Dose and a Booster?

The short answer is, yes, there is. According to the Centers for Disease Control (CDC), “an additional [third] dose is administered to people with moderately to severely compromised immune systems. This additional dose of an mRNA COVID-19 vaccine is intended to improve immunocompromised people’s response to their initial vaccine series. A booster shot is administered when a person has completed their vaccine series, and protection against the virus has decreased over time” (Source: www.cdc.gov/coronavirus/2019-ncov/ vaccines/recommendations/immuno.html).

What this means: Your provider should administer additional doses to patients for whom the initial immune response following a primary COVID-19 vaccine series is likely to be insufficient. This includes people who have:

• Been receiving active cancer treatment for tumors or cancers of the blood
• Received an organ transplant and are taking medicine to suppress the immune system
• Received a stem cell transplant within the last two years or are taking medicine to suppress the immune system
• Moderate or severe primary immunodeficiency (such as DiGeorge syndrome, Wiskott-Aldrich syndrome)
• Advanced or untreated HIV infection
• Active treatment with high-dose corticosteroids or other drugs that may suppress your immune response (Source: www.cdc.gov/coronavirus/2019-ncov/vaccines/ recommendations/immuno.html).

On the other hand, your provider should administer booster shots to patients who received the initial one- or two-dose COVID-19 vaccines but who need another shot to strengthen their immune response, which has waned over time.

• People 65 years and older, 50–64 years with underlying medical conditions, or 18 years and older who live in long-term care settings should receive a booster shot.
• People 18 years and older should receive a booster shot at least 2 months after receiving their Johnson & Johnson/Janssen COVID-19 vaccine (Source: www. cdc.gov/coronavirus/2019-ncov/vaccines/booster-shot.html?s_cid=11710:cdc third dose covid vaccine recommendations:sem. ga:p:RG:GM:gen:PTN.Grants:FY22).

Once your provider has made the determination on whether a patient needs an additional dose or a booster, here’s how you will code the services depending on the vaccine brand.

Master the Moderna Vaccine

To report first, second, and third doses: Use vaccine code 91301 (… COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage, for intramuscular use) with the appropriate vaccine administration code:

• 0011A (Immunization administration by intramuscular injection of … COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 100 mcg/0.5 mL dosage; first dose)
• 0012A (… second dose)
• 0013A (… third dose).

To report booster doses: Use vaccine code 91306 (… COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 50 mcg/0.25 mL dosage, for intramuscular use) with administration code 0064A (… 50 mcg/0.25 mL dosage; booster dose).

Check Out the Johnson & Johnson Single-Dose Vaccine Advice

To report first dose: Use vaccination code 91303 (… COVID-19 vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5mL dosage, for intramuscular use) with administration code 0031A (Immunization administration by intramuscular injection of … COVID-19 vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative free, 5x1010 viral particles/0.5 mL dosage; single dose).

To report booster doses: Use vaccination code 91303 with administration code 0034A (… booster dose).

Fixate on This Pfizer-Biontech Vaccine Information

To report first, second, and third doses: Use vaccine code 91300 (… COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3mL dosage, diluent reconstituted, for intramuscular use) with the appropriate vaccine administration code:

• 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).
• 0002A (… second dose)
• 0003A (… third dose).

To report booster doses: Use vaccination code 91300 with administration code 0004A (… booster dose).

Note This New Pfizer-Biontech Tris-Sucrose Vaccine

To report first, second, and third doses: Use vaccination code 91305 (… COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation, for intramuscular use) with the appropriate vaccine administration code:

• 0051A (Immunization administration by intramuscular injection of … COVID-19 vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; first dose)
• 0052A (… second dose)
• 0053A (… third dose)

To report booster doses: Use vaccination code 91305 with administration code 0054A (… booster dose).

Coding Alert: At the time of going to press, the Food and Drug Administration (FDA) has given the Pfizer-BioNTech tris-sucrose formulation — 91305 — emergency use authorization (EUA) but not full FDA authorization, while the Moderna booster — 91306 — is awaiting both EUA and full authorization.

For more information: consult the September Update of CPT^® Assistant by going to www.ama-assn.org/system/files/ cpt-assistant-guide-coronavirus-september-2021.pdf.