Pulmonology Coding Alert

Question: What codes should I report for pneumonia vaccinations given in our office?


New Hampshire Subscriber

Answer: The vaccine code that you report depends on the patient's age. You should report 90732 (Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, for use in individuals 2 years or older, for subcutaneous or intramuscular use) for patients over age 2. The appropriate diagnosis code to report with this vaccine administration is V03.82 (Streptococcus pneumoniae [pneumococcus]).

Children under 2 should routinely receive Prevnar, the 7 conjugate vaccine, which is most likely administered in a pediatrician's office. If your office administers the vaccine, however, report the service with 90669 (Pneumococcal conjugate vaccine, polyvalent, for children under 5 years, for intramuscular use) and V03.82.

The code you report for the administration of the vaccine depends on the insurer. For the administration of the pneumonia vaccine to a Medicare beneficiary, use G0009 (Administration of pneumococcal vaccine when no physician fee schedule service on the same day).

For those insurers that do not follow Medicare guidelines, use 90471 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intramuscular injections]; one vaccine [single or combination vaccine/toxoid]).