ACOG Coding FAQs for Physicians
Correct coding helps ensure that a practice receives payment for vaccines given to patients. ACOG has published a coding guide solely focused on immunization, Immunization Coding for Obstetrician-Gynecologists 2013, and a quick glance guide for frequently used immunization codes. Proper coding means being sure that the code selected is appropriate as follows:
The code represents the most accurate description of “what” was performed and “why” it was performed consistent with coding conventions and guidelines
The code is supported by documentation in the medical record
The Current Procedural Terminology (CPT) coding guidelines state that the code selected must be the most accurate description of the service provided and be consistent with coding conventions and guidelines. Individuals responsible for coding should carefully review their coding books, including any coding guidelines, notes, instructions, or other explanatory statements. These may be printed under subsections, headings, subheadings, or before and after codes. The physician also should know the bundling and unbundling rules used by CPT, commercial payers, and the Centers for Medicare & Medicaid Services.
ICD-10 Implementation: The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), implementation in the United States has been delayed due to congressinal action until October 1, 2015. ACOG believes Fellows need to remain prepared for this change, and will continue to provide resources such as workshops, newsletters, and alerts regarding the new timeline. As additional updates and resources regarding this change become available, they will be posted at the link below.
· ACOG’s ICD-10 Coding Information Section
ACOG Coding Quick Glance Guides: (scroll past physician script to reach coding information)
Click here to register for ACOG’s coding e-newsletter.
To learn more about Coding, visit ACOG’s Coding Page. Email firstname.lastname@example.org with additional questions. If you are an ACOG Fellow, please include your membership identification number in your email inquiry.
Frequently Asked Coding Questions
Many obstetric-gynecologic practices now routinely offer immunization services to their patients. Correct coding enables a physician’s office to report these services to third-party payers and to receive appropriate reimbursement for these services.
What codes should I submit for vaccine administration services?
The appropriate CPT vaccine administration code should be submitted in addition to the appropriate CPT or Healthcare Common Procedure Coding System vaccine product code. These codes should be linked to the appropriate ICD-9 code to support the medical necessity of the vaccine administration services.
Are vaccine administration services included in a preventive medicine service?
Although the general discussion of vaccines is part of age-appropriate preventive medicine counseling, the actual administration of the vaccine and the vaccine product should be billed separately.
Are vaccine administration services included in global obstetric care?
No. Vaccination services performed during pregnancy should be billed separately at the time of service. A separate E/M services should not be reported because the obstetric office visit is part of the global obstetric package.
How are vaccine administration services reported when a nurse or qualified health care professional provides the service?
The appropriate CPT vaccine administration code and CPT or Healthcare Common Procedure Coding System vaccine product code should be reported and linked to the appropriate ICD-9 code. If a significant separately identifiable E/M services is performed by the nurse at the time of the visit, it may be appropriate to report E/M code 99211 in addition to the vaccine administration services.
What services are considered inherent components of a vaccine administration code?
Inherent components include making an appointment for the patient, pulling the chart, billing, and filling the chart. Clinical services such as greeting the patient, taking vital signs, reviewing vaccine history and allergies, and noting vaccine administration on the chart are also considered inherent components of this service.
Does Medicare cover vaccine administration services?
Medicare covers the cost and administration of influenza vaccine (yearly), pneumococcal vaccine (once per lifetime), and hepatitis B vaccine (for those in medium-risk to high-risk categories). Medicare does not cover other vaccines unless they are directly related to the treatment of an injury or direct exposure to a disease or condition (eg, tetanus or rabies exposure).
Is physician counseling bundled into vaccine administration services?
If the patient is aged 18 years or younger, CPT codes that include counseling by a physician or other qualified health care professional may be reported if the physician or qualified health care professional provides face-to-face counseling during administration of the vaccine. If the patients is older than 18 years, it may be appropriate to bill an E/M visit code in addition to the vaccine administration code if the counseling by the physician or qualified health care provider exceeds the usual services included in vaccine administration.
How do I code for multiple vaccines administered at the same visit?
Report the appropriate CPT “add-on” administration code of reach additional vaccine given on the same date of service in addition to the appropriate vaccine product codes (CPT or Health Care Common Procedure Coding System) for the additional vaccines.
Is it appropriate to report a vaccine administration code with a problem-oriented E/M services?
If a significant, separately identifiable E/M services is performed, the appropriate E/M service code should be reported in addition to the vaccine administration code.
Last Updated: 4/10/2014