Pulmonology Coding Alert

Question: Several patients have come into our practice for their annual flu vaccines. Some of these patients haven’t received their most recent COVID-19 vaccine booster for which they are eligible. Providers in the practice will administer the COVID-19 vaccine booster if the patients are seeking it, in addition to the flu vaccine.

Since the patients weren’t up to date on their COVID-19 vaccines upon arrival at our practice, should we assign Z28.311 in addition to the vaccine administration and vaccine supply codes?

Arizona Subscriber

Answer: No, you shouldn’t assign Z28.311 (Partially vaccinated for COVID-19) nor Z28.310 (Unvaccinated for COVID-19) during these encounters. These two ICD-10-CM codes were added to the code set in April 2022 to specify the patient’s vaccination status for the COVID-19 vaccine.

These codes won’t apply to vaccine administration encounters. The codes are better suited for evaluation and management (E/M) services or when the unvaccinated or partially vaccinated status could play a role in the patient’s condition or treatment plan if the patient is ill.

For example, a patient comes into your practice with a harsh cough, fever, shortness of breath, and body aches. The provider performs a COVID-19 rapid test, which comes back positive. If the provider documents in the medical record that the patient is unvaccinated against COVID-19, then you could assign U07.1 (COVID-19) and Z28.310 as the diagnosis codes.