Tetanus and Diphtheria Vaccinations Billing GuidelinesCPT CodeICD-1090715S61011A90471S61011AAug 30, 2018
Medical providers who “buy and bill” for the Tdap vaccine should use the Current Procedural Terminology (CPT) code 90715. For administration of the vaccine, providers should bill CPT code 90471 or 90472, as appropriate.
ICD-10 requires only one code (Z23) per vaccination, regardless if single or combination. Report Z23 for all vaccination diagnoses.
Code Z23, which is used to identify encounters for inoculations and vaccinations, indicates that a patient is being seen to receive a prophylactic inoculation against a disease. If the immunization is given during a routine preventive health care examination, Code Z23 would be a secondary code.
Counseling is provided by the physician. Bill administration using 1 unit of 90460. Example: DTaP-IPV/Hib, a 5-component vaccine, is administered to a pediatric patient, and counseling is provided by the nurse practitioner. Bill for administration using 1 unit of 90460 and 4 units of 90461.
ICD-10 code A33 for Tetanus neonatorum is a medical classification as listed by WHO under the range - Certain infectious and parasitic diseases .
For immunization administration other than COVID-19, codes 90460–90474 are reported for the administration of the vaccine, along with the appropriate vaccine/toxoid code (90476–90756) targeting the organism.
If the immunization is related to exposure (eg, the administration of a Tdap vaccine as a part of wound care), the ICD-10 code describing the exposure should be used as the primary diagnosis code for the vaccine, and Z23 should be used as the secondary code.
When coding for immunizations, which of the following should be assigned? (When coding for immunizations, two codes should be assigned: one for the vaccine or immunization material as well as a code for the administration of the vaccine.)
DTaP vaccine can prevent diphtheria, tetanus, and pertussis. Diphtheria and pertussis spread from person to person. Tetanus enters the body through cuts or wounds. DIPHTHERIA (D) can lead to difficulty breathing, heart failure, paralysis, or death.
vaccinationCode 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. All Z codes must be accompanied by a corresponding procedure code.
IIS: NDC Lookup CrosswalkSale NDC11Sale Proprietary NameUse GTIN00006-4133-41Tetanus and Diphtheria Toxoids Adsorbed00006-4171-00ProQuad0030006417101300006-4329-02VAXNEUVANCE00006-4329-03VAXNEUVANCE33 more rows
For vaccines given the same day as a G-Code vaccine, use 90471. For example, if a patient receives a flu shot and tetanus shot, you would bill G0008 for the flu vaccine and 90471 for the tetanus vaccine; also add modifier 59 (distinct procedural service) to the G code.
For billing purposes, you will bill for 10 units of service under CPT 90376 (1485 IUs/150 IU per unit of service = 9.9 (or 10) units of service). The NDC Units Dispensed would be ML9. 9. i There are 2 possible NDCs for the ActHIB component of this vaccine.
Immunization administration for90472: Immunization administration for percutaneous, intra-dermal, subcutaneous or intramuscular injections, each additional vaccine. 90474: Immunization administration for intra-nasal or oral route, each additional vaccine.
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