The Centers for Disease Control and Prevention (CDC) recently updated COVID-19 vaccine recommendations, which affect all doses of Janssen’s vaccine and monovalent vaccines from Pfizer and Moderna.
Janssen’s vaccine no longer is available for use in the United States. In addition, the monovalent vaccines from Pfizer and Moderna are no longer authorized, which means bivalent versions of mRNA COVID-19 vaccines should be used for all doses in patients ages 6 months and older.
In response to these changes, the American Medical Association (AMA), in collaboration with the CDC and Centers for Medicare & Medicaid Services, released six new Current Procedural Terminology (CPT) immunization administration codes to support the tracking of and payment for COVID-19 vaccines. Other codes were revised.
Guidelines
Per the AMA, the selection of CPT codes is based on the vaccine product, the patient’s age and which dose in the series is administered.
In an effort to streamline vaccine administration guidelines, “booster dose” has been replaced with “additional dose.” Similar to previous COVID-19 vaccine administration codes, counseling is included as part of vaccine administration.
Documentation for counseling should include the vaccine component and risks and benefits discussed. Some payers also require the documentation of any questions asked by the patient and parent/caregiver.
Documentation for vaccine administration should include any COVID-19 vaccines that were administered previously. These vaccines will be used to calculate which dose is being administered at the current visit. For example, if a patient previously had a two-dose series of a monovalent vaccine and then receives a bivalent vaccine, the administration code would be for a third or additional dose, depending on whether a code for a third dose exists for that product.
For more information, visit the AAP coding webpage at https://bit.ly/3C1LQ7C.
Vignettes
An 8-month-old infant is brought to the office for COVID-19 vaccination. The patient previously was vaccinated with one dose of a monovalent vaccine. The physician counsels the parents on the risks and benefits of the vaccine and administers a 25 mcg/0.25 mL dose of the Moderna bivalent vaccine.
Appropriate codes would be:
- CPT code 91314 Moderna bivalent 25 mcg/0.25 mL dosage
- CPT code 0142A for administration of the second dose
- International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) code Z23 Encounter for immunization
- National Drug Code (NDC) 80777-0282-05
A 12-year-old boy, who is an established patient, is brought to the office for an annual preventive visit. His parents are concerned because he has not received any COVID-19 vaccines. No abnormal findings were identified during the preventive portion of the visit. The physician counsels the parents on the risks and benefits of the COVID vaccine and administers 30 mcg/0.3 mL of the Pfizer bivalent vaccine.
Appropriate codes would be:
- CPT code 99394 preventive medicine reevaluation and management of an individual established patient; adolescent (age 12 through 17 years)
- CPT code 91312 Pfizer bivalent, 30 mcg/0.3 mL dosage
- CPT code 0121A for the administration of the first dose
- ICD-10-CM code Z00.129 Encounter for routine child health examination without abnormal findings
- ICD-10-CM code Z23 Encounter for immunization
- NDC 59267-1404-01 or 59267-0304-01 based on the volume of the product, either a single dose or multiple-dose vial
A 4-year-old girl is seen for a follow-up visit for otitis media. During the visit, the physician suggested updating her COVID-19 vaccines based on new guidelines from the CDC. She previously received two doses of Pfizer’s monovalent vaccine. The physician counsels the parents on the risks and benefits of the vaccine and administers 3 mcg/0.2 mL of the Pfizer bivalent vaccine.
Appropriate codes would be:
- CPT code 99212-99215 (select applicable office visit code for established patients)
- CPT code 91317 Pfizer bivalent, 3 mcg/0.2 mL dosage
- CPT code 0173A for the administration of the third dose
- ICD-10-CM code H66.90 Otitis media, unspecified, unspecified ear
- ICD-10-CM code Z23 Encounter for immunization
- NDC 59267-0609-01
Although the public health emergency has ended, COVID-19 continues to be a complicated coding concept, partially due to changing recommendations for treatment and prevention as well as the need to track outcomes to improve care. As with all coding concepts, documentation is key in appropriate reporting of COVID-19 vaccine administration.
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