Primary Care Coding Alert

Experts give 4 reasons to assign a specific ICD-9 code for each immunization You may be tempted to save yourself some time and report V20.2 every time your family physician administers a vaccination. But resist the temptation.

ICD-9 and coding experts say this isn't the best idea. Here's why: 1. ICD-9 Calls for Highest-Specificity Reporting Using the specific diagnosis code correctly will inform the insurer why you performed the vaccine administration. That's why you should use the specific vaccine code rather than attaching V20.2 (Health supervision of infant or child; routine infant or child health check) to the vaccines. For example: You give a 2-month-old baby her first of three hemophilus influenza B (Hib) vaccine shots. You should link V03.81 (Other specified vaccinations against single bacterial diseases; hemophilus influenza, type B [Hib]) to 90647 (Hemophilus influenza B vaccine [Hib], PRP-OMP conjugate [3-dose schedule], for intramuscular use). Code V03.81 tells the payer that you inoculated the child against Hib. If you use V20.2 instead of V03.81, you are incorrectly reporting that you performed a "routine infant or health check" instead of simply saying that you administered an Hib shot. 2. Avoid Costly Errors With Improved Tracking Taking the time to link each ICD-9 code to the appropriate immunization code will benefit your practice financially. You'll have better claim tracking, which may alert you to potentially costly coding mistakes, says Albert Jacobsen, MD, CPA, in "Strategies to Optimize Reimbursement for Pediatric Vaccinations," a teleconference presented by The Coding Institute.

For instance, billing tetanus-diphtheria (90718, Tetanus and diphtheria toxoids [Td] adsorbed for use in individuals seven years or older, for intramuscular use) instead of varicella (90716, Varicella virus vaccine, live, for subcutaneous use) can cost you almost $48. (The difference is based on Medicare's 2004 drug allowable rates, which give $10.31 to 90718 and $57.86 to 90716.) Because the vaccines appear alphabetically on the superbill and the numbers are similar, you might easily interchange the procedure codes. But, if you see the varicella diagnosis (V05.4, Need for other prophylactic vaccination and inoculation against single diseases; varicella) linked to Td (90718), you can easily check the patient's chart to determine which vaccine the physician administered. Cross-reference the diagnosis with the procedure code to help you avoid missing vaccines. Here's how: Suppose your chart reflects three vaccine diagnoses but only two vaccine procedures. You can see which procedure you omitted and add the potentially missed code. 3. Use Specific Codes to Save Well Visits Reserving V20.2 for well visits will help you avoid losing preventive exam payment. Many payers restrict the number of well visits a child may have, says Jean Ryan-Niemackl, LPN, CPC, a training specialist with QuadraMed Government Services in Fargo, N.D. Consequently, [...]