Vaccine Coding Amid the Pandemic

Vaccine administration and product codes are expanding.

The Centers for Medicare & Medicaid Services  (CMS) released updates to the ICD-10-PCS codes on Dec. 1, 2020, while the most recent release of CPT® codes was Jan. 25, 2021.  With the release of vaccines, the American Medical Association (AMA) has released frequent updates to the CPT codes and CMS has been releasing the HCPCS codes for the vaccine products.    The updates are frequent, so it is important to review the information on a timely basis.

There is only one diagnosis code for the immunization administration in ICD-10-CM which is Z23.  This code should be applied when a patient receives the COVID-19 vaccine.   The ICD-10-PCS codes for the administration of the vaccine were recently released which include the following:

For outpatient coding, the vaccine administration and product codes are expanding.  The most recent release from CMS has included the Moderna and Pfizer vaccines and the administration of the vaccines.

The recent list includes vaccines that are in development. Please note that there are different codes for the administration of each vaccine as well as the product. See the list below for the current vaccines and the associated administration:

This list includes proposed vaccines and their associated administration:

Currently, the government is covering the cost of the vaccine, but organizations may charge for the administration of the vaccine.

If you have not discussed your facility specific coding guidelines with respect to data collection for COVID, then now is the time to begin that discussion. The AMA is expanding the CPT codes and CMS has added new vaccine product codes as new vaccines are developed.  Do you know which departments need the COVID-19 vaccine administration information? Has the administration been hard coded in the chargemaster or does it need to be assigned by HIM? The answers to these questions are going to impact your facility coding guideline development.

Programming Note: Listen to Laurie Johnson’s coding report today and every Tuesday during Talk Ten Tuesdays, 10 a.m. Eastern.

Resources:

https://www.cms.gov/medicare/medicare-part-b-drug-average-sales-price/covid-19-vaccines-and-monoclonal-antibodies

https://www.cms.gov/medicare/icd-10/2021-icd-10-pcs