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:

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.

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.

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, if you use V20.2 for immunizations, you may exhaust the child's well benefits.

Why: Assigning V20.2 may trigger the insurer to apply well-care maximum benefits to the immunizations. The payer's system may use the preventive exam diagnosis (V20.2) to count the number of well visits (99381-99397, Preventive medicine services). Therefore, the vaccine uses one of the child's preventive visits and makes the vaccine code subject to the patient's deductible, Ryan-Niemackl says.

You may hesitate to use individual ICD-9 codes because doing so creates a long claim. Payers only allow five lines for reporting procedures, Jacobsen says. So, if you have a claim for a 15-month-old who comes in for a well check and is behind on immunizations, you could have seven codes.

In this case, you may be tempted to revert to billing +90472 (Immunization administration ...) with multiple units using one unit for each vaccine administration. But, billing based on units won't allow you to match the correct ICD-9 code to the procedure, Jackson says, because the different units may reflect vaccines with different diagnosis codes.

Better way: Set up your computer system to automatically generate a separate ticket if you report the add-on code 90472. Make sure you link the appropriate vaccination diagnosis to each administration and immunization code.

Correct claim: You should code well visits with immunizations based on the following example:

A parent presents with her 15-month-old infant for a preventive medicine exam, and you give the measles, mumps and rubella (MMR) and diphtheria, tetanus toxoids, acellular pertussis, and Hib (DtaP-Hib) vaccines.

For this encounter, please see chart.