Vaccine Coding: Cpt And Icd-10 Explained

The Current Procedural Terminology (CPT) and the International Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification (ICD-10-CM) are both coding systems used in the healthcare industry. CPT codes are used for reporting immunizations, while ICD-10-CM codes are used for diagnoses and inpatient procedures. In the context of vaccines, both CPT and ICD-10 codes are relevant and applicable. For example, during the COVID-19 pandemic, new CPT and ICD-10 codes were developed for reporting testing, treatment, vaccination, and diagnoses. Additionally, specific CPT and ICD-10 codes are associated with certain vaccines, such as GARDASIL®9 and VAXELIS®. These codes are important for billing and reimbursement purposes, and they vary depending on the payer's specific requirements.

CPT and ICD-10 codes for GARDASIL®9

Vaccines do have CPT and ICD-10 codes. CPT stands for Current Procedural Terminology, and ICD-10 stands for International Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification.

GARDASIL®9 (Human Papillomavirus 9-valent Vaccine, Recombinant) is a vaccine indicated in females aged 9 through 45 years for the prevention of cervical, vulvar, vaginal, anal, oropharyngeal, and other head and neck cancers caused by HPV Types 16, 18, 31, 33, 45, 52, and 58. Merck Vaccines provides a list of CPT and ICD-10 codes that may be relevant for GARDASIL®9 and its administration. These codes may apply to private payer reimbursement claims for vaccinations with GARDASIL®9. However, it is important to note that plan coding requirements may vary, so it is recommended to check with each plan for specific requirements.

The following are some of the commonly used CPT and ICD-10 codes for GARDASIL®9:

CPT Codes:

• 90650: Human Papillomavirus Vaccine, 9-valent, for intramuscular injection (IM), 0.5 mL dosage
• 90651: Human Papillomavirus Vaccine, 9-valent, for intramuscular injection (IM), 0.5 mL dosage, includes counseling provided to the patient/family about the use of the vaccine

ICD-10 Codes:

• Z23: Encounter for immunization against human papillomavirus
• Z71.6: Counseling for prevention of cervical cancer
• Z12.81: Encounter for screening for human papillomavirus

These codes are subject to change, and it is the responsibility of the user to determine the appropriate codes for billing purposes and to consult with a qualified professional advisor.

CPT and ICD-10 codes for VAXELIS®

Vaccines do have CPT and ICD-10 codes. CPT stands for Current Procedural Terminology, and it is a registered trademark of the American Medical Association. ICD-10, on the other hand, stands for International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification.

VAXELIS® is a vaccine that combines diphtheria and tetanus toxoids, acellular pertussis, inactivated poliovirus, haemophilus b conjugate, and hepatitis B. It is distributed by Merck and Sanofi for MSP Vaccine Company and is a trademark of MSP Vaccine Company.

The CPT and ICD-10 codes for VAXELIS® are as follows:

• Z23 is reported for all vaccine-related encounters for all vaccines given, in addition to any health exam ICD-10-CM codes.
• NDC, National Drug Code: The NDCs are the billable NDCs that appear on the carton and the unit of use when NDC is required by the payer.
• CVX Code: Indicates the product used in a vaccination.
• MVX Code: Indicates the manufacturer of a vaccine.

It is important to note that the use of these codes does not guarantee payment or that the payment received will cover all costs. Diagnosis codes should be selected only by a healthcare professional. Payer coding requirements can vary and frequently change, so it is essential to check with each payer regarding their specific requirements.

ICD-10-CM codes for COVID-19 vaccination status

Vaccines do have CPT and ICD-10 codes. CPT stands for Current Procedural Terminology, and ICD-10-CM stands for International Classification of Diseases and Related Health Problems, Tenth Revision, Clinical Modification.

In response to the COVID-19 public health emergency, the CDC's National Center for Health Statistics (NCHS) implemented new diagnosis codes into the ICD-10-CM for reporting COVID-19 vaccination status. These codes, Z28.310, Z28.311 and Z28.39, came into effect on April 1, 2022, and are to be used for discharges occurring from October 1, 2021 – September 30, 2022.

Prior to this, in January 2021, the CDC had introduced six new diagnosis codes into the ICD-10-CM, in response to the COVID-19 public health emergency. These codes were effective from January 1, 2021, and were to be used for discharges occurring from October 1, 2020 – September 30, 2021.

It is important to note that Z23 is reported for all vaccine-related encounters for all vaccines given, and in addition to any health exam ICD-10-CM codes.

CPT codes for COVID-19 vaccines

Vaccines do have CPT and ICD-10 codes. CPT stands for Current Procedural Terminology and is a registered trademark of the American Medical Association. ICD-10, on the other hand, stands for the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Clinical Modification.

In response to the COVID-19 pandemic, the CPT Editorial Panel approved five new COVID-19 vaccine product codes and one administration code in August 2023. These new codes replaced all previously approved specific COVID-19 product and administration codes, except for the Novavax vaccine product code 91304. The CPT code 0053A, for instance, is used to document the Pfizer tris-sucrose formulation booster shot. The CPT code 91311 is used for the Moderna COVID-19 vaccine's third dose, which is administered at a different dosage than the original formulation. The Novavax vaccine, which is also a COVID-19 vaccine, is assigned the CPT code 91304.

The CDC's National Center for Health Statistics (NCHS) implemented three new diagnosis codes, Z28.310, Z28.311, and Z28.39, into the ICD-10-CM in response to the COVID-19 public health emergency. These codes are for reporting COVID-19 vaccination status, effective April 1, 2022.

CPT and ICD-10 codes for reimbursement

CPT and ICD-10 codes are crucial for providers to receive proper reimbursement when performing medical procedures. CPT, or Current Procedural Terminology, is a registered trademark of the American Medical Association. Each CPT code corresponds to a specific service, and private and public payers use these codes to determine appropriate reimbursement rates. CPT codes are used during each treatment session to describe the services rendered and ensure that the therapy provided is accurately recorded in the patient's medical record. CPT codes are not "profession-specific", meaning any qualified healthcare professional can utilise a CPT code as long as the code description fits the procedure or service they are providing.

ICD-10 codes, on the other hand, are used in the initial evaluation of a patient to provide a clinical rationale for why a particular therapy is required. These codes help prove that the therapy is addressing a legitimate health concern and is not elective or unnecessary. For example, if a patient is diagnosed with lateral epicondylitis (tennis elbow) in the right elbow, the therapist must use the ICD-10 code M77.11 to document the condition.

In the context of vaccines, both CPT and ICD-10 codes are essential for reimbursement. For example, VAXELIS®, a vaccine for diphtheria, tetanus, pertussis, inactivated poliovirus, haemophilus b conjugate, and hepatitis B, has specific CPT and ICD-10 codes for billing and reimbursement. Similarly, GARDASIL®9, a human papillomavirus 9-valent vaccine, also has corresponding CPT and ICD-10 codes for reimbursement claims.

During the COVID-19 public health emergency, the CDC's National Center for Health Statistics implemented new ICD-10-CM codes for reporting COVID-19 vaccination status, further highlighting the importance of these codes in vaccine reimbursement. It is important to note that payer coding requirements can vary and frequently change, so healthcare providers must stay up-to-date with the latest codes to ensure accurate billing and reimbursement.

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