Tetanus and Diphtheria Vaccinations Billing GuidelinesCPT CodeICD-1090715S61011A90471S61011AAug 30, 2018
Code Z23 is used to indicate any encounter for a vaccination. The procedure codes are used to identify the type of the immunization given and how it was administered.
For the TDAP vaccine, report CPT code 90715 (pays approximately $31).
ICD-10 requires only one code (Z23) per vaccination, regardless if single or combination. Report Z23 for all vaccination diagnoses.
ICD-10-CM Description Clinicians may assign code Z28. 311, “Partially vaccinated for COVID-19,” when the patient has received at least one dose of a multi-dose COVID-19 vaccine regimen, but has not received the doses necessary to meet the CDC definition of “fully vaccinated” at the time of the encounter.
The Z23 code includes the following note: “Code first any routine childhood examination.” Therefore, when you provide immunizations in conjunction with a well-child visit, a code for routine child health examination should be reported first, followed by Z23 for any immunizations. This is similar to ICD-9 rules.
Z23 may be used as a primary diagnosis for immunizations in the OP and physician setting.
IIS: NDC Lookup CrosswalkSale NDC11Sale Proprietary NameMVX Code00006-4133-41Tetanus and Diphtheria Toxoids AdsorbedMSD00006-4171-00ProQuadMSD00006-4329-02VAXNEUVANCEMSD00006-4329-03VAXNEUVANCEMSD33 more rows
Medicare prescription drug coverage (Part D) usually covers all commercially available vaccines needed to prevent illness, including the Tdap shot.
A35 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. The 2022 edition of ICD-10-CM A35 became effective on October 1, 2021. This is the American ICD-10-CM version of A35 - other international versions of ICD-10 A35 may differ.
The 90460 code is used when a physician is present and performs face-to-face counseling to the caregiver or parent. This code can only be used for patients through age 18. Code 90471 is used when the drug is administrated by a medical assistant or nurse and the patient does not see the physician at all.
Vaccine Administration Code(s) Administration codes track which dose in the regimen is being administered. NDC 10/NDC11 The National Drug Code (NDC) uniquely identifies human drugs in the United States; it can be found on the vial containing the vaccine.
GY Modifier: This modifier is used to obtain a denial on a non-covered service. Use this modifier to notify Medicare that you know this service is excluded.
Immunizations, vaccinations, or inoculations are covered by Medicare only when there has been direct exposure of the associated disease to the patient and there is significant risk that the patient could contract the disease as a result of the exposure.
The 90460 code is used when a physician is present and performs face-to-face counseling to the caregiver or parent. This code can only be used for patients through age 18. Code 90471 is used when the drug is administrated by a medical assistant or nurse and the patient does not see the physician at all.
Code 90472, “Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections), each additional vaccine (single or combination vaccine/toxoid),” may be used in conjunction with code 90460 only when a physician provides counseling for one immunization and does not provide ...