Combination Vaccine Dxs


ICD-9 2011: Your Options for Combination Vaccine Product

ICD-9 does not include specific diagnosis for every combination vaccine product. In these cases, ICD-9CM instructs you to use the appropriate V06.X code of combination diseases. And then to also identify any vaccine that is not included in the V06 appropriate fourth digit ICD-9 code.

For instance, to code Kinrix which includes DTaP and IPV, per ICD-9 coding guideline, you would use V06.1 for the DTaP which includes the Diphtheria, tetanus and acellular pertussis. And you would also need to use V04.0 for the polio.

These guidelines will be simplified. Revised ICD-9 guidelines will allow you to code only the generic combination vaccine code V06.8. So for Kinrix, you would need only V06.8 and not have to report the combination DTaP and IPV code.

You won't however find the revised guidelines in your ICD-9 2011 book. These were printed before the American Academy of Pediatrics was able to work with ICD-9 to change the reporting requirements based on the multiple vaccine combination ICD-9 coding guidelines being too cumbersome.

Let's be clear on when you'll be using the V06.8 code. You don’t need to report a vaccine ICD-9 code with every vaccine or vaccine administration CPT code.

When vaccines are administered in conjunction with a preventive medicine service, ICD-9 guidelines allow 20.2 to be the universal ICD-9 code. The vaccine code may be listed as the second code. You don’t want to use V20.2 and vaccine administration counters outside preventive medicine services like catch up vaccine encounters or flu clinics.

Because recording V20.2 when in preventive medicine service has not been provided could cause the payer system to consider that encounter as a preventive medicine service. When the patient reaches the allotted number of preventive medicine services that the insurer covers for that year, you'll get a denial for that preventive medicine service as the patient will have accidentally used up all of his or her covered annual preventive medicine services.

Coding following CPT or ICD-9 guidelines is called optimal coding. Some payers however require you do instead link the specific ICD-9 vaccine code to the vaccine and vaccine administration codes. And use V20.2 with only the preventive medicine service code.

Provided you have the ultimate guideline in writing by traditional paper letter, female, payer policy article or even a representative directive verified with representative name, phone number and date of discussion, you should code following these acceptable guidelines. Make sure that you put the documentation support for the acceptable method in your healthcare compliance plan as proof of why you're coding this way.

Here's an example of acceptable coding for an 11-year old’s preventive medicine service with vaccinations of DTaP and Menactra with no vaccine counseling. We use V20.2 with only the preventive medicine service and then coded each vaccine and administration with the related ICD-9 vaccine code.

So here, the payer can easily see that this vaccine administration are length, they're using the me ICD-9 code. And the Menactra vaccine and the admin, you should always have in your payer with the related ICD-9 code.

Here's optimal coding for the some example. Code each vaccine administration with V20.2 as primary diagnosis. And optionally, also report the related ICD-9 vaccine as a secondary diagnosis.

Often on audits, you find that there's a mismatch amount of these codes. So people have actually provided more vaccines and not coded for each administration. Having this additional diagnosis makes it easy for the coder and biller to realize that there's not an even match because there's not a payer for each of these.

Now, stop panicking over how you're going to keep all the components straight. The next four slides are your cheat sheets for how many components each product contains. Not all of us know what vaccines are included in every product, active or Pediarix.

You can look up each vaccine product by manufacture name and get the included number of components, the vaccine with counseling codes to use and the corresponding ICD-9 codes to use.

For acceptable and non-preventive medicine service coding encounters. For instance, Decavac contains vaccines for both tetanus and diphtheria, for the vaccine administration with counseling codes, you would use 90460 for the first component and 90461 for the second component.

ICD-9 has a specific combination vaccine code for TD which is V06.5. You would use this code of preventive medicine services based on payer requirements. And that vaccine administration encounters outside preventive medicine services. So this is our ICD-9 code listed here for acceptable coding and non-preventive medicine service coding.

For complete and up to date information on family practice coding and billing, visit family practice coding and billing page.

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