Immunizations: The road to better health

August 17th, 2018 / By Karla VonEschen, CPC

Is it really August 2018? For many of us, this time of year means planning one final summer vacation, getting kids ready for a new school year, or thinking about our own healthcare needs and making sure we are up to date on vaccinations. For those of us that work in health care, it means an influx of patients being seen for immunizations and billing for those visits. August is recognized as National Immunization Awareness month by the Center for Disease Control (CDC), so this topic seemed appropriate for the month.

Immunizations are one of the most cost-effective ways to prevent individual disease, but that’s not their only benefit. As more and more individuals get immunizations, society gains a collective immunization against a particular disease. Take polio for example. This disease was eliminated in 1979 after vaccinations against the disease became widespread. Here are some additional facts about vaccines you may not be aware of:

  • According to the CDC, it’s estimated 21 million hospitalizations and more than 700,000 deaths will be avoided for children born since 1998 due to vaccinations.
  • Influenza, which is preventable by vaccine, costs approximately $10 billion annually.
  • For adults over 50, influenza, pneumococcal disease, shingles and pertussis (which are all vaccine preventable diseases), cost approximately $26 billion annually.
  • Childhood vaccines could potentially save $13 billion in direct costs.

We can see the benefit of vaccination from a cost perspective, so let’s look at some tips for billing vaccinations.

  1. Remember to report code Z23 once for all vaccinations performed during a given encounter. If the patient is seen for a vaccination, and this is the only concern addressed, Z23 would be the only diagnosis coded.
  2. Include vaccine/toxoid codes 90476-90749 when appropriate. The exception to reporting this code is if the drug was supplied for free, which is the case with some state Medicaid programs.
  3. Per CPT guidance, immunization administration codes 90460, 90461 or 90471-90474 should be reported in addition to the vaccine and toxoid codes. Remember to review patient age as physician counseling for the administration of vaccines for patients over 18 years of age should be reported with codes 90471-90474.
  4. If the patient is also seen for a significant separately identifiable evaluation and management service, the appropriate E/M code may be billed in addition to the vaccine and toxoid administration code. Physician documentation in this case is critical to support the E/M service.
  5. Pay close attention to component codes. Codes such as 90460, 90471 and 90473 all have an add-on code for “each additional vaccine….”

As the summer of 2018 winds down and we move into fall, encourage your friends, family and patients to talk with their physician, get immunized, and work toward better health for everyone. For additional information on age specific immunization recommendations, please visit the Centers for Disease Control website.

Karla Voneschen is a coding analyst at 3M Health Information Systems.