Pulmonology Coding Alert

Question: I’ve noticed that the respiratory syncytial virus (RSV) vaccine CPT^® code descriptors list the formula as a monoclonal antibody.

Should we report Z29.11 for RSV immunizations instead of Z23?

Montana Subscriber

Answer: No, you would assign Z23 (Encounter for immunization) to report an RSV vaccine administration. That’s because ICD-10-CM code Z29.11 (Encounter for prophylactic immunotherapy for respiratory syncytial virus (RSV)) is reserved for high-risk patients who require protection against RSV. These patients can include infants, patients with cystic fibrosis, and immunocompromised individuals.

Remember these accompanying CPT^® RSV administration codes: In the CPT^® code set, three RSV vaccine codes are a monoclonal antibody formula while the other two codes are prefusion (preF) vaccine products:

• 90378 (Respiratory syncytial virus, monoclonal antibody, recombinant, for intramuscular use, 50 mg, each)
• 90380 (Respiratory syncytial virus, monoclonal antibody, seasonal dose; 0.5 mL dosage, for intramuscular use)
• 90381 (Respiratory syncytial virus, monoclonal antibody, seasonal dose; 1 mL dosage, for intramuscular use)
• 90678 (Respiratory syncytial virus vaccine, preF, subunit, bivalent, for intramuscular use)
• 90679 (Respiratory syncytial virus vaccine, preF, recombinant, subunit, adjuvanted, for intramuscular use)

Note: Effective Oct. 6, 2023, the AMA released two new RSV administration codes. You’ll assign either of the codes when a qualified healthcare provider administers 90380 or 90381.

The new administration codes are:

• 96380 (Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection, with counseling by physician or other qualified health care professional)
• 96381 (Administration of respiratory syncytial virus, monoclonal antibody, seasonal dose by intramuscular injection)