Medical Coding For Vaccines – Why It’s Different

  • Medical Billing and Coding
  • March 11, 2024
  • 4 min read
Medical billing and Coding

Vaccine coding is done differently to most medical coding and is often a source of confusion for newly qualified medical coders. So, to make things as clear as possible, we’ll be breaking down how coding for vaccines is done and how it differs from regular codes.

A Three-Part Code 

Vaccine codes are split into three sections: 

  • the administration of the vaccine
  • the vaccine toxoid itself
  • the vaccine diagnosis code

This means that, as the medical coder, you will need to provide a code for the nurse giving the vaccine shot as part of the administration section, the code for the particular vaccine being administered, and the code for the diagnosis that lead to the vaccine in the first place.

Two of these codes will be procedure (CPT) codes, in this case, the admin and toxoid with the third code, for the diagnosis, being the ICD-9 code. To make things even more complicated, the diagnosis code usually is what is referred to as a V-code, which indicates that the patient is receiving a vaccine of some sort.

Coded in Order

The most complicated part of coding for a vaccine is that each vaccine administration has to be coded in the order in which it was given. This means that if a patient were given more than one vaccine, which is common during childhood vaccinations, the first vaccine would have a different administration fee to the second vaccine.

If the patient were given more than two vaccines, you’d need to code for the first admin fee, then the second admin fee, multiplied by the additional number of shots. 

There are also different administration fees for vaccines that are given subcutaneously and intramuscularly compared to those that are given orally or nasally.

This would mean that a patient coming in for three vaccines given subcutaneously and one given orally would generate eight different codes.

New CMC Counseling Codes

To make matters even more complicated, because of the large number of parents concerned about the possible health risks or side effects of vaccines, the Centers for Medicare and Medicaid Services (CMS) have introduced new vaccine administration codes for doctors counseling parents on the complete lack of risks associated with vaccination.

This means coders now coders have to know whether or not the doctor counseled the patient, as well as how and which vaccine was given.

Lots of Moving Parts

The difficulty with vaccine coding is the sheer number of codes that the coder has to assemble to code a single vaccine fully. Up to four codes can be needed for a since shot, including the counseling code, administration code, toxoid code, and diagnosis code.

Learning why and how vaccines are coded differently makes the who process less cryptic, even if it doesn’t lessen the workload associated with gathering all the right information together.

A Vital Part Of The Healthcare Cycle

Taken together, medical coding and billing form a link between patients, healthcare providers, and insurance companies. As a medical biller or coder, you’ll need to be accurate, detail-oriented, and well organized as you’ll be a vital part of any healthcare provider’s staff.

As one of the premier Medical Billing and Coding Schools in Las Vegas, Northwest Career College employs established, seasoned instructors to teach you every aspect of medical billing and coding. Our student-focused approach puts you first, and we offer online and on-campus workshops to accommodate your work and family schedule.

We continue to support our students after they graduate as our experienced Career Services team works with you to help you find the medical billing and coding jobs in Las Vegas. Call us today on (702) 403-1592 to learn more about the exciting opportunities that our Medical Billing and Coding School can offer you!

Nancy Ferrante
Medical Billing & Coding Senior Program Chair

Nancy began her career as a Medical Assistant in 1979. From there, Nancy mastered many other areas of the medical field. She spent 35 years in Ohio, building a successful medical practice with the same Physician until his retirement in…Read Full Bio

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