Even after continued discussion, some parents may continue to refuse vaccines. The information and resources below describe how to code for and document discussions. Additionally, there are general strategies to consider to reduce vaccine liability for any office that administers vaccines.
How to Code for Vaccine Counseling When No Vaccine is Administered
A 2-month old patient is brought in by her parents for her check-up. The patient received her Hepatitis B vaccine at birth, but since then the parents have refused vaccines. At the well-exam, the pediatrician takes the time to review what is needed and the importance of vaccines. He answers their questions and provides them with educational information on the safety of vaccines. The parents wish to defer a little longer. The baby is healthy. The physician documents 8 minutes of vaccine counseling. What can be coded?
|Z00.129 Well child exam||99391 Preventive medicine service, < 1 year|
|Z71.89 Other specified counseling|||
|Z28.82 Immunization not carried out because of caregiver refusal|||
Teaching Point: You cannot code separately for the vaccine counseling during the well child exam due to CPT rules. The counseling is considered part of the well child exam. You would use the ICD codes for parental refusal and counseling.
Parents of an established 6-week-old patient are reluctant to immunize their infant. During an encounter to address parent concerns about diaper rash, the physician spends an additional 10 minutes counseling the parents about current recommendations, safety of vaccines, efficacy, and the importance of vaccines.
The parents refuse vaccines during this visit but are going to think about their decision. The physician documents the parents’ concerns and responses to the concerns, recommendations and resources provided, and plan for follow-up at the upcoming 2-month well-child visit. The time spent in vaccine counseling is also specifically documented (eg, “Spent 10 minutes discussing parents’ concerns about immunization”). Assuming that the history, examination, and medical decision making to address the diaper rash support a 99212-level E/M service, the following codes may be reported for this encounter:
|L22 Diaper Rash||99212 25|
|Z71.89 Other specified counceling|
Z28.82 Immunization not carried out because of cargiver refusal
|99401 Preventive medicine counseling, 15 mins|
Teaching Point: Modifier 25 is appended to the problem-oriented E/M code (99212) as directed by the prefatory language for codes 99401–99429. Counseling on vaccines provided by a physician or other QHCP (eg, physician assistant, nurse practitioner) is not separately reported when vaccines are administered at the same encounter. See codes 90460–90461 to report counseling
AAP Refusal to Vaccinate Form
Health care providers may decide it is in their best interest to formally document a parent's refusal to accept vaccination for a minor child. This form, (also available in Spanish and Microsoft Word ) which should not be considered a legal document without advice from a lawyer, may be used as a template for such documentation.
The current AAP Clinical Report, Countering Vaccine Hesitancy, provides information about addressing parental concerns about vaccination. It can assist pediatricians with understanding vaccine development and safety monitoring processes, and it reviews the current state of vaccine exemptions, discusses communication strategies for responding to parental concerns and considers the option of dismissal from a practice of families which refuse vaccinations.
The current AAP Policy, Responding to Parental Refusals of Immunization of Children, can assist pediatricians in understanding the reasons parents may have for refusing to immunize their children, review the limited circumstances under which parental refusals should be referred to child protective services agencies or public health authorities, and provide practical guidance to assist the pediatrician faced with a parent who is reluctant to allow immunization of his or her child.