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Bright Future and Preventive Medicine Coding Fact Sheet

Updated 01/01/2016
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NOTE: This resource contains comprehensive listings of codes that may not be used by your practice on a regular basis. We recommend that you identify the codes most relevant to your practice and include those on your encounter form/billing sheet.

Following are the Current Procedural Terminology (CPT®), Healthcare Common Procedure Coding System (HCPCS) Level II, and International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes most commonly reported by pediatricians in providing preventive care services. It is strongly recommended that the pediatrician, not the staff, select the appropriate code(s) to report.

Preventive Medicine Service Code

  • ​To report the appropriate preventive medicine service code, first determine if the patient qualifies as new or established (defined in the next 2 sections), and then select the appropriate code within the new or established code family based on patient age.
  • Preventive medicine service codes are not time-based; therefore, time spent during the visit is not relevant in selecting the appropriate preventive medicine services code.
  • If an illness or abnormality is encountered or a preexisting problem is addressed in the process of performing the preventive medicine service, and if the illness, abnormality, or problem is significant enough to require additional work to perform the key components of a problem-oriented evaluation and management (E/M) service (history, physical examination, medical decision-making), the appropriate office or other outpatient service code (99201–99215) should be reported in addition to the preventive medicine service code. Modifier 25 should be appended to the office or other outpatient service code to indicate that a significant, separately identifiable E/M service was provided by the same physician on the same day as the preventive medicine service. 
  • An insignificant or trivial illness, abnormality, or problem encountered in the process of performing the preventive medicine service that does not require additional work and performance of the key components of a problem-oriented E/M service should not be reported.
  • The comprehensive nature of the preventive medicine service codes reflects an age- and gender-appropriate history and physical examination and is not synonymous with the comprehensive examination required for some other E/M codes (eg, 99204, 99205, 99215).
  • Immunizations and ancillary studies involving laboratory, radiology, or other procedures, or screening tests (eg, vision, developmental, and hearing screening) identified with a specific CPT® code, are reported separately from the preventive medicine service code.

Preventive Medicine Services: New Patients
Initial comprehensive preventive medicine E/M of an individual includes an age- and gender-appropriate history; physical examination; counseling, anticipatory guidance, or risk factor reduction interventions; and the ordering of laboratory or diagnostic procedures.

CPT Codes ICD-10-CM Codes
99381 Infant (younger tha​n ​1 year)Z00.110 Health supervision for newborn under 8 days old
Z00.111 Health supervision for newborns 8 to 28 days old or
​​Z00.121 Routine child health exam with abnormal findings
Z00.129 Routine child health exam without abnormal findings
99382 Early childhood (age 1–4 years)Z00.121  Z00.129
99383 Late childhood (age 5–11 years)
99384 Adolescent (age 12–17 years)
99385 18 years or olderZ00.00 General adult medical exam without abnormal findings
Z00.01 General adult medical exam with abnormal findings

 
A new patient is defined as one who has not received any professional face-to-face services rendered by physicians and other qualified health care professionals who may report E/M services and reported by a specific CPT® code(s) from a physician/other qualified health care professional, or another physician/other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years.

Preventive Medicine Services: Established Patients
Periodic comprehensive preventive medicine reevaluation and management of an individual includes an age- and gender-appropriate history; physical examination; counseling, anticipatory guidance, or risk factor reduction interventions; and the ordering of laboratory or diagnostic procedures.​

CPT Cod​es ICD-10-CM Codes
99391 Infant (younger than 1 year)Z00.110 Health supervision for newborn under 8 days old
Z00.111 Health supervision for newborns 8 to 28 days old or
Z00.121 Routine child health exam with abnormal findings
Z00.129 Routine child health exam without abnormal findings
99392 Early childhood (age 1–4 years) Z00.121 
Z00.129
99393 Late childhood (age 5–11 years)
99394 Adolescent (age 12–17 years)
99395 18 years or older Z00.00 General adult medical exam without abnormal findings
Z00.01 General adult medical exam with abnormal findings


Counseling, Risk Factor Reduction, and Behavior Change Intervention Codes

  • ​Used to report services provided for the purpose of promoting health and preventing illness or injury.
  • They are distinct from other E/M services that may be reported separately when performed. However, there is one exception—you cannot report counseling codes (99401– 99404) in addition to preventive medicine service codes (99381–99385 and 99391–99395).
  • Counseling will vary with age and address such issues as family dynamics, diet and exercise, sexual practices, injury prevention, dental health, and diagnostic or laboratory test results available at the time of the encounter.
  • Codes are time-based, where the appropriate code is selected based on the approximate time spent providing the service. Codes may be reported when the midpoint for that time has passed. For example, once 8 minutes are documented, one may report 99401.
  • Extent of counseling or risk factor reduction intervention must be documented in the patient chart to qualify the service based on time.
  • Counseling or interventions are used for persons without a specific illness for which the counseling might otherwise be used as part of treatment.
  • Cannot be reported with patients who have symptoms or established illness.
  • For counseling individual patients with symptoms or established illness, report an office or other outpatient service code (99201–99215) instead.
  • For counseling groups of patients with symptoms or established illness, report 99078 (physician educational services rendered to patients in a group setting) instead.

Preventive Medicine, Individual Counseling

99401 Preventive medicine counseling or risk factor reduction intervention(s) provided to an individual; approximately 15 minutes
99402Preventive medicine counseling or risk factor reduction intervention(s) provided to an individual; approximately 30 minutes
99403Preventive medicine counseling or risk factor reduction intervention(s) provided to an individual; approximately 45 minutes
99404Preventive medicine counseling or risk factor reduction intervention(s) provided to an individual; approximately 60 minutes
 
Behavior Change Interventions, Individual 
  • Used only when counseling a patient on smoking cessation (99406–99407).
  • If counseling a patient's parent or guardian on smoking cessation, do not report these codes (99406–99407) under the patient; instead, refer to preventive medicine counseling codes (99401–99404) if the patient is not currently experiencing adverse effects (eg, illness) or include under the problem-related E/M service (99201–99215).
99406Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes
99407Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes
99408 Alcohol or substance abuse (other than tobacco) abuse structured screening (eg, Alcohol Use Disorder Identification Test [AUDIT], Drug Abuse Screening Test [DAST]) and brief intervention (SBI) services; 15 to 30 minutes
99409Alcohol or substance abuse (other than tobacco) abuse structured screening (eg, AUDIT, DAST) and brief intervention (SBI) services; greater than 30 minutes

 
Preventive Medicine, Group Counseling

99411Preventive medicine counseling or risk factor reduction intervention(s) provided to individuals in a group setting; approximately 30 minutes
99412Preventive medicine counseling or risk factor reduction intervention(s) provided to individuals in a group setting; approximately 60 minutes

ICD-10-CM Codes for Counseling Risk Factor Reduction and Behavior Change Interventions
  • The diagnosis code(s) reported for counseling risk factor reduction and behavior change intervention codes will vary depending on the reason for the encounter.
  • Remember that the patient cannot have symptoms or established illness; therefore, the diagnosis code(s) reported cannot reflect symptom(s) or illness(es).
  • Examples of some possible diagnosis codes includ
ICD-10-CM Code​​Descriptor
Z28.3​Uderimmunization status
Z71.3​Dietary surveillance and counseling
Z71.41Alcohol abuse counseling and surveillance of alcoholic
Z71.42Counseling for family member/partner/friend of alcholic
Z71.51Drug abuse counseling and surveillance of drug abuser
Z71.52Counseling for family member/partner/friend of drug abuser

Z71.6

Tobacco abuse counseling
Z71.89 Other specified counseling
Z71.9​Counseling, unspecified
Z87.891​Personal history of nicotine dependence
Z91.89​Other specified personal risk factors, presenting as hazards to health not elsewhere classified


Other Preventive Medicine Services

Oral Health
CPT ​Code
99188​Applicatoin of topical fluoride varnish by a physician or other qualified health care professional

ICD-10-CM Codes
Z00.121
Z00.129
Z41.8​Encounter for other procedures for purposes other than remedying health state


Pelvic Examination
  • Preventive medicine service codes (99381–99385 and 99391–99395) include a pelvic examination as part of the age- and gender-appropriate exam​ination.
  • However, if the patient is having a problem, the physician can report an office or other outpatient E/M service code (99212–99215) for the visit and attach modifier 25, which identifies that the problem-oriented pelvic visit is a separately identifiable E/M service by the same physician on the same date of service.
  • Link the appropriate ICD-10-CM code for the well-child or well-adult exam with abnormal findings (Z00.121 or Z00.01) to the preventive medicine service code, but link a different diagnosis code (eg, N89.8 [vaginal discharge], N94.4 [primary dysmenorrhea]) to the office or other outpatient E/M service code (eg, 99212).
  • Anticipatory or periodic contraceptive management is not a "problem" and therefore is included in the preventive medicine service code; however, if contraception creates a problem (eg, breakthrough bleeding, vomiting), the service can be reported separately with an office or other outpatient service code.

ICD-10-CM Codes 

ICD-10-CM Code Descriptor
Z01.411Gynecological exam with abnormal findings
Z01.419
Gynecological exam without abnormal findings
Z11.51​Screening for human papillomavirus (HPV)
Z12.72​Screening for malignant neoplasm of vagina
Z30.011​Initial prescription of contraceptive pills
Z30.012 Prescription of emergency contraception
Z30.013
Initial prescription of injectable contraceptive
Z30.014​Initial prescription of intrauterine contraceptive device
Z30.02​Counceling and instruction in natural family planning to avoid pregnancy
Z30.02Counceling and instruction in natural family planning to avoid pregnancy
Z30.09​General counceling and advice on contraception
Z30.40​Surveillance of contraceptives, unspecified
Z30.41​Surveillance of contraceptive pills
Z30.42​Surveillance of injectable contraceptive
Z30.430Insertion of IUD
Z30.431​Routine checking of IUD
Z30.432​Removal of IUD
​​Z30.433​Removal and reinsertion of IUD
Z30.49​Surveillance of other contraceptives

 
Health Risk Assessment

CPT Code

99420

Administration and interpretation of health risk assessment instrument (eg, health hazard appraisal)

NOTE: This code can be reported for a postpartum screening   administered to a mother as part of a routine newborn check   but can be billed under the baby’s name. Link to ICD-10-CM   code Z00.121 or Z00.129 for a normal screen during a   routine well-baby exam. Check with your payers.​

 
Unlisted Preventive Medicine Service
99429 Unlisted preventive medicine service
 
Report code 99429 only when a more specific preventive medicine service code does not exist.

Case Management or Care Plan Oversight Services

Telephone Services
CPT Codes
99441Telephone E/M service by a physician or other qualified health care professional who may report E/M services provided to an established patient, par​ent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5 to 10 minutes of medical discussion
99442​      11 to 20 minutes of medical discussion
99443​      21 to 30 minutes of medical discussion
 
Online Medical Evaluation
CPT Code
99444Online E/M service provided by a physician or other qualified health care professional who may report E/M services provided to an established patient or guardian not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network
 
Care Plan Oversight
CPT Codes
99339 Individual physician supervision of a patient (patient not present) in home, domiciliary, or rest home (eg, assisted living facility) requiring complex and multidisciplinary care modalities involving regular physician development or revision of care plans; review of subsequent reports of patient status; review of related laboratory and other studies; communication (including telephone calls) for purposes of assessment or care decisions with health care professional(s), family member(s), surrogate decision maker(s) (eg, legal guardian), or key caregiver(s) involved in patient’s care; integration of new information into medical treatment plan; or adjustment of medical therapy; within a calendar month; 15 to 29 minutes
99340       30 minutes or more

  • ​Care plan oversight (CPO) codes are reported once per calendar month.
  • Telephone service codes are reported for each physician telephone call made or received from a patient or parent, excluding those that occur 7 days after or 24 hours before a face-to-face visit.
  • The online medical evaluation code is reported only once for the same episode of care during a 7-day period, although multiple physicians can report their exchanges with the same patient.
  • If the online medical evaluation refers to an E/M service previously performed and reported by a physician within the previous 7 days (physician requested or unsolicited patient follow-up) or within the postoperative period of the previously completed procedure, the service is considered covered by the previous E/M service or procedure.
  • For the online medical evaluation code, a reportable service encompasses the sum of communication (eg, related telephone calls, prescription provision, laboratory orders) pertaining to the online patient encounter.
  • The CPO codes include telephone calls and online medical evaluations; therefore, if you include time spent on a telephone call or an online medical evaluation toward your monthly CPO billing, you cannot also separately report that service.


Care coordination Service

99490 Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month, with the following required elements:
  • multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient;
  • chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline;
  • comprehensive care plan established, implemented, revised, or monitored.
​Chronic care management of less that 20 minutes is not separately reported. Do not report this code in addition to any other non–face-to-face service code (eg, CPO or telephone care) within the same calendar month.​ ​
99487​Complex chrone care management services, with the following required elements:
  • ​multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient
  • chronic conditions place the patient at the significant risk of death, acute exacerbation.
  • establishment or substantial revision of a comprehensive care plan;
  • moderate or high complexity medical decision making;
  • 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

99489

each additional 30 mintues of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List deparately in addition to code 99487.)

  • Do not report for complex chronic care management that is under 60 minutes in a calendar month. 

Transitional Care Management Services

99495 Trasctional care management services with the following required elements:

  • Communication(direct contact, telephone, electronic) with the patient and/ or caregiver within 2 business days of discharge
  • Medical decision-making of atleast moderate complexity during the service period
  • Face-to-face visit, within 14 calender days of discharge. 

99496 Transitional care management services with the following required elements:
  • Commnication(direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge.
  • ​Medical decision-making of high complexity during the service period
  • Face-to-face visit, within 7 calender days of discharge

Reporting of complexity chronic care coordination and transition care management requires that a lot of criteria be met and guidelines followed. Please refer to the 2014 CPT manual for complete details.

Screening Codes

Vision Screening

CPT Codes ICD-10-CM Codes
99173 Screening test of visual acuity Z00.121 Routine child health exam with abnormal findings
99174 Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral​​Z00.129 Routine child health exam without abnormal findings
99177 Instru​ment-based ocular screening (eg, photoscreening, automated-refration), bilateral, with on-site analysis
 

Z01.00 and Z01.01 (examination of eyes and vision with and without abnormal findings) are reported for routine examination of eyes and vision only and not reported when a vision screen is done during a routine well-child exam.

  • To report code 99173, you must employ graduate visual acuity stimuli that allow a quantitative estimate of visual acuity (eg, Snellen chart).
  • Codes 99174 and 99177 are reported for instrument-based ocular screening for esotropia, exotropia, anisometropia, cataracts, ptosis, hyperopia, and myopia.
  • Code 99177 is reported in lieu of 99174 when the screening instrument provides you with immediate pass/fail results.
  • When acuity (99173) or instrument-based ocular screening (eg, 99174) is measured as part of a general ophthalmologic service or an E/M service of the eye (eg, for an eye-related problem or symptom), it is considered part of the diagnostic examination of the office or other outpatient service code (99201–99215) and is not reported separately.
  • Other identifiable services unrelated to the screening test provided at the same time are reported separately (eg, preventive medicine services). 
  • ailed vision screenings will most likely result in a follow-up office visit (eg, 99212–99215). Report the follow-up screen with Z01.00 if normal or Z01.01 if abnormal. If abnormal, link to the diagnosis code for the reason for the failure (eg, H52.1- [myopia]); when a specific disorder cannot be identified, report R94.118(abnormal results of other function studies of eye).

Hearing Screening

CPT Codes ICD-10-CM Codes
92551 Screening test, pure tone, air onlyZ00.121 Routine child health exam with abnormal findings
92552 Pure tone audiometry (threshold); air only​​ Z00.129 Routine child health exam without abnormal findings
92567 Tympanometry (impedance testing)

​Codes Z01.10 (encounter for exam of ears and hearing without abnormal findings) and Z01.118 (encounter for exam of ears and hearing with other abnormal findings) are only reported when a patient presents for an encounter specific to ears and hearing and not for a routine well-child exam where a hearing screen is performed.

  • Requires use of calibrated electronic equipment; tests using other methods (eg, whispered voice, tuning fork) are not reported separately.
  • Includes testing of both ears; append modifier 52 when a test is applied to only one ear.
  • Other identifiable services unrelated to the screening test provided at the same time are reported separately (eg, preventive medicine services).
  • Failed hearing screenings will most likely result in a follow-up office visit (eg, 99212–99215). Code Z01.110 (encounter  for hearing exam following failed hearing screening) is reported when a specific disorder cannot be identified or when the follow-up hearing screen is normal. You can also report Z01.118 (encounter for exam of ears and hearing  with other abnormal findings) and include the code for  the abnormal results, like R94.120 (abnormal auditory function study).

Developmental Screening and Emotional/Behavioral Assessment

CPT Code ICD-10-CM Code
96110 Developmental screening, with scoring and documentation, ​ Z13.4 Encounter for screening for certain developmental disorders in childhood (excludes developmental screening during a routine well child exam)
96127 Vrief emotional/behavioral assessment (eg, depression inventory) with scoring and documentation, per standardized instrumentZ13.89 Encounter for s​creening for other disorder (eg. depressio
  • Used to report administration of standardized developmental screening instruments (96110) or behavioral/ emotional assessments (96127). 
  • CD-10-CM code Z13.4 is not to be used for routine developmental screening performed during a routine wellchild exam. ICD-10-CM code Z13.89 is not necessary to report in addition to a well-child exam.
  • Often reported when performed in the context of preventive medicine services but may also be reported when screening or assessement is performed with other E/M services such as acute illness or follow-up office visits.
  • Clinical staff (eg, registered nurse) typically administers and scores the completed instrument while the physician incorporates the interpretation component into the accompanying E/M service.
  • When a standardized screen or assessment is administered along with any E/M service (eg, preventive medicine service), both services should be reported and modifier 25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) should be appended to the E/M code to show the E/M service was distinct and necessary at the same visit.
  • Examples of 96110 instruments include, but are not limited to
    • Squires J, Bricker D. Ages & Stages Questionnaires (ASQ-3). 3rd ed. Baltimore, MD: Paul H. Brookes Publishing Co, Inc; 2009 and Squires J, Bricker D, Twombly E. Ages & Stages Questionnaires: Social-Emotional (ASQ:SE). Baltimore, MD: Paul H. Brookes Publishing Co, Inc; 2002
    • Robins D, Fein D, Barton M. Modified Checklist for Autism in Toddlers (M-CHAT). 1999
    • Ireton H. Child Development Review System. Minneapolis, MN: Behavior Science Systems, Inc
    • Glasco FP. Parents' Evaluation of Developmental Status. Nashville, TN: Ellsworth & Vandermeer Press LLC; 2006
  • ​Examples of 96127 instruments include, but are not limited to
    • Australian Scale for Asperger's Syndrome. In: Attwood T. Asperger's Syndrome: A Guide for Parents and Professionals. London, England: Jessica Kingsley Publishers; 1997
    • Reynolds CR, Kamphaus RW. BASC-2: Behavior Assessment Scale for Children. 2nd ed. Upper Saddle River, NJ: Pearson School Publishing; 2004
    • Gioia GA, Isquith PK, Guy SC, Kenworthy L. Behavioral Rating Inventory of Executive Function (BRIEF). Lutz, FL: Psychological Assessment Resources, Inc; 2000
    • Wetherby AM, Prizant BM. Communication and Symbolic Behavior Scales Developmental Profile (CSBS DP). Baltimore, MD: Paul H. Brookes Publishing Co, Inc; 2002
    • Jellinek M, Murphy M. Pediatric Symptom Checklist. http:// www.massgeneral.org/psychiatry/services/psc_home.aspx. Accessed December 1, 2015
    • Vanderbilt Assessment Scales. In: ADHD: Caring for Children With ADHD; A Resource Toolkit for Clinicians. 2nd ed. Elk Grove Village, IL: 2011

​Immuniz​ations

Immunization Administration

Pediatric Immunization Administration (IA) Codes

90460     Immunization administration (IA) through 18 years  of age via any route of administration, with counseling by physician or other qualified​ health care professional; first or only component of each vaccine or toxoid administered​

+90461   each additional vaccine or toxoid component administered

Report 90461 in conjunction with 90460

Component refers to all antigens in a vaccine that prevent disease(s) caused by one organism. Multivalent antigens or multiple serotypes of antigens against a single organism are considered a single component of vaccines. Combination vaccines are those vaccines that contain multiple vaccine components. Conjugates or adjuvants contained in vaccines  are not considered to be component parts of the vaccine as defined previously.

A qualified health care professional is an individual who by education, training, licensure/regulation, facility credentialing (when applicable), and payer policy is able to perform a professional service within his or her scope of practice and independently report a professional service. These professionals are distinct from clinical staff. A clinical staff member is a person who works under the supervision of a physician or other qualified health care professional and who is allowed by law, regulation, facility, and payer policy to perform or assist in the performance of specified professional services but who does not individually report any professional services.

Code 90460 is used to report the first or only component in a

single vaccine given during an encounter. You can report more than one 90460 during a single office encounter. Code 90461 is considered an add-on code to 90460 (hence the + symbol next to it). This means that the provider will use 90461 in addition to 90460 if more than one component is contained within a single vaccine administered. CPT® codes 90460 and 90461 are reported regardless of route of administration.

Pediatric IA codes (90460–90461) are reported only when both of the following requirements are met:

  1. The patient must be 18 years or younger.
  2. T he physician or other qualified health care professional must perform face-to-face vaccine counseling associated with the administration. (Note: The clinical staff can do the actual administration of the vaccine.)

    If both of these requirements are not met, report a nonagespecific IA code(s) (90471–90474) instead.

Non-Age-Specific Immunization Administration Codes
Report a CPT and an ICD code for each vaccine administation as well as for each vaccine product given during a patient encounter.
90471

IA (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccin​e/toxoid)​
Do not report 90471 i​n conjunction with 90473.​

+90472; each additional vaccine (single or combination vaccine/toxoid) (List separately to code for primary procedure.)

Use 90472 in conjunction with 90460, 90471 or 90473.
90473IA (includes intranasal or oral administration); one vaccine (single or combination vaccine/toxoid)

Do not report 90473 in conjunction with 90471.
+90474; each additional vaccine (single or combination vaccine/toxoid) (List separately to code for primary procedure.)

Use 90474 in conjunction with 90460, 90471 or 90473.
 

Codes 90471 and 90473 are used to code for the first immunization given during a single office visit. Codes 90472 and 90474 are considered add-on codes (hence the + symbol next to them) to 90460, 90471, and 90473. This means that the provider will use 90472 or 90474 in addition to 90460, 90471, or 90473 if more than one vaccine is administered during a visit. Note that there can only be one first administration during a given visit. (See vignettes #3, 4, and 5 on pages 28–30.)

​If during a single encounter for a patient 18 years or younger, a physician or other qualified health care professional only counsels on some of the vaccines, report code 90460 (and 90461 when applicable) for those counseled on and defer to codes 90472 or 90474 as appropriate for those that are not counseled on.

The following vignettes may help illustrate their correct use (please note that these coding vignettes are for teaching purposes and do not necessarily follow every payer's reporting requirements): 


Vignette #1

A 5-year-old established patient is at a physician's office for her annual well-child examination. The patient is scheduled to receive her first hepatitis A vaccine; her fifth diphtheria, tetanus, and acellular pertussis (DTaP) vaccine; and the influenza vaccine. After distributing the Vaccine Information Statements and discussing the risks and benefits of immunizations with her parents, the physician administers the vaccines.

How are the appropriate code(s) for this service selected?

Step 1: Select appropriate E/M code.
99393 Preventive medicine service, established patient, age 5 to 11 years

Step 2: Select appropriate vaccine product code(s).
90633 Hepatitis A vaccine, pediatric/adolescent dosage (2-dose schedule), for intramuscular use
90700DTaP, for use in individuals younger than 7 years, for intramuscular use
90672Influenza virus vaccine, quadrivalent, live, for intranasal use

 
Step 3: Select appropriate immunization administration code(s) by considering the following questions:

  • Is the patient 18 years or younger?
  • If the patient is younger than 18 years, did the physician or other qualified health care professional perform the faceto-face vaccine counseling, discussing the specific risks and benefits of the vaccine(s)?​

If the answer to both questions is "yes," select a code(s) from the pediatric IA code family (90460–90461). If the answer to one of the questions is "no," select a code from the nonagespecific IA code family (90471–90474).

In this vignette, the answer to both questions is "yes." Therefore, the following IA codes will be reported:


90460    IA through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered

+90461  each additional vaccin​e or toxoid component administered (List separately in addition to code for primary procedure.)​


Step 4: Select the appropriate ICD-10-CM diagnosis code(s).

Diagnosis codes are used along with CPT® codes to reflect the outcome of a visit. CPT codes tell a carrier what was done and ICD-10-CM codes tell a carrier why it was done.

The vaccine product CPT code and its corresponding IA CPT code are always linked to the same ICD-10-CM code. This is because the vaccine product and the work that goes into administering that product are intended to provide prophylactic vaccination against a certain type of disease.

ICD-10-CM lists only a single code to describe an encounter in which a patient does receive a vaccine. The code is Z23 and it is reported at any encounter when a vaccine is given, including routine well-child or adult exams.

The diagnosis codes for the 3 vaccines and the 3 IA codes used in this vignette are as follows:

CPT Code ICD-10-CM Code
90633*Preventive medicine service, est patient, 5-11 years​ Z00.129
90633Hepatitis A vaccine serum Z23
90460Pediatric IA (hepatitis A vaccine), first component ​Z23
90700DTaP vaccine product​ ​Z23
90460Pediatric IA (DTaP vaccine), first component ​Z23
90461 (x2)Pediatric IA (DTaP vaccine), each additional component ​Z23
90672Influenza virus vaccine, quadrivalent, live , intranasal ​Z23
90460Pediatric IA (influenza vaccine), first component ​Z23
 
​Alternate Coding
CPT Codes
ICD-10-CM Codes
99393*Preventive medicine service, established patient, 5-11 years Z00.129
90633​Hepatits A vaccine product​​Z23
​90700DT​aP vaccine product​ ​Z23
​90672​Influenza virus vaccine, quadrivalent, live, intranasal ​Z23
​90460 (x3)​Pediatric IA (hepatits A, DTaP, influenza vaccines), first component ​Z23
​90461 (x2)​Pediatric IA (DTaP vaccine), second and third components ​Z23

* At time of publication there was a National Correct Coding Initiative (NCCI) edit on all E/M services and IA codes. Append modifier 25 to the E/M service when also reporting IA codes. 

Please note that most payers do not want multiple line items of codes 90460 or 90461; therefore, follow the alternative coding. 

Rationale
Because the patient is younger than 18 years and there is physician counseling, pediatric IA codes are reported (90460, 90461). Each vaccine administered will be reported with its own 90460 (hepatitis A, DTaP, influenza). The only vaccine with multiple components is DTaP. Because the first component (ie, diphtheria) was counted in 90460, only the second and third components (tetanus and acellular pertussis) are reported with 90461 with 2 units. Also, even though an intranasal vaccine is administered, 90460 is still reported because the code descriptor reads "any route."


Vignette #2
A 2-month-old established patient presents for her check up. The following vaccines are ordered DTaP-Hib-IPV(Pentacel), pneumococcal, and rotavirus. The physician counsels the parents on all of them and the nurse administers.
CPT Code ICD-10-CM Code
99391Preventive medicine service, est patient, < 1 yearZ00.129
90698DTaP-Hib-IPV (Pentacel) productZ23
90670Pneumococcal productZ23
90680Rotavirus vaccine, oral use Z23
90460 (x3)Pediatric IA (Pentac​el, Pneumococcal, rotavirus), first component Z23
90461 (x4)Pediatric IA (Pentacel), each additional componentZ23
 
Rationale
Because the patient is younger than 18 years and there is physician counseling, pediatric IA codes are reported (90460, 90461). Clinical staff may administer the vaccine. Even though an oral vaccine is administered, you still report 90460 because the code descriptor reads "any route."

Vignette #3

A 19-year-old patient presents to the office to complete a college physical examination (in college the patient will be living in a dorm). He is due for a tetanus-diphtheria-acellular pertussis (Tdap) booster, meningococcal vaccine, and intranasal influenza vaccine. The physician counsels the patient on each and the nurse administers each.


CPT Code ICD-10-CM Code
99395*Preventive medicine service, est patient, 18-39 yrs Z02.0
90715Tdap product Z23
90471IA, first injection​ Z23
90734Meningococcal (MCV4) serum Z23
90472IA, each additional injection Z23
90672Influenza virus vaccine, quadrivalent, live serum, intranasal Z23
90474IA, each additional oral or intranasal Z23
* At the time of publication there was an NCCI edit on all E/M services and IA codes. Append modifier ​25 to the E/M service when also reporting IA codes
Rationale
The patient is older than 18 years; therefore, despite physician counseling, pediatric IA codes cannot be reported. Instead, codes 9047190474 must be used. Because the patient received 2 injections and 1 intranasal vaccine, code 90471 is reported for the first injection, 90472 for the second injection, and 90474 for the intranasal vaccine. It is important to remember that a first injection code (90471) cannot be reported in addition to a first oral or intranasal code (90473); therefore, code 90474 must be used.

Vignette #4
A 17-year-old patient presents to the office for her annual checkup and to complete the college physical examination (in college the patient will be living in a dorm.) The patient is healthy and due for a Tdap booster, meningococcal vaccine, first HPC (9-valent) vaccine, and intranasal influence vaccine. The physician counsels the patient only on the meningococcal and HPC vaccines and the nurse administers each. The patient is then asked to return in  to 6 weeks for her second HPV vaccine. 
CPT Code
(First Visi​t Only)
ICD-10-CM Code​s
(First Visit Only
99394* 
​Preventive medicine service, established patient, 12-17 years ​Z00.00 and Z02.0
90734Meningococcal (MCV4) serum Z23
90651​HPV (9-valent) prod​uctZ23
90460 (x2)Pediatric IA (meningococcal), and HPV, first componentZ23
90715Tdap serum Z23
90472IA, each additional injection (Tdap) Z23
90672Influenza virus vaccine, quadrivalent, live, intranasal Z23
90474IA, each additional oral or intranasal Z23
  * At time of publication there was an NCCI edit on all E/M services and IA codes. Append modifier ​25 to the E/M service when also reporting IA codes
Rationale

Because the physician only documents counseling for the meningococcal and HPV vaccines, code 90460 can only be reported for those vaccines because the patient meets the age criteria. For the Tdap and intranasal influenza vaccines, defer to non-pediatric IA codes (9047190474). In this case, however, a first vaccine code is already reported with code 90460, so the additional IA codes (90472, 90474) have to be reported based on route of administration. While ICD-10-CM does not provide official ages for the "adult" ICD-10-CM codes (Z00.00 and Z00.01) in lieu of the child well exam codes, many payers  use age 17 years as the cutoff. Refer to specific payer policy  for details.​


Vignette #5

A 6-month-old patient presents to the office for her routine checkup and to receive vaccines. The patient is due for DTaP, pneumococcal, and hepatitis B vaccines. During the examination the physician finds an upper respiratory infection and fever. The physician counsels the parent on the vaccines but decides to defer for 2 weeks. The physician completes the well-baby check on that day.

Two weeks later the patient returns. The patient is afebrile and asymptomatic and is only seen by the nurse. The DTaP, pneumococcal, and hepatitis vaccines are administered. 

​CPT Codes (First Visit)
ICD-10-CM Codes (First Visit)
99391​Preventive medicine service, established patient, <1 yearZ00.121
 (An appropriate acute sick visit (eg, 99213) may be reported in addition with modifier 25 and linked to an appropriate ICD-10-CM code.)


CPT Codes
(2 Weeks Later)
ICD-10-CM Codes
(2 weeks later)
90700DTaP product​Z23
90670​Pneumococcal product Z23
90744​Hepatitis B vaccine product​​ Z23
Z2390471​IA (DTaP), first vaccine Z23
​90472 (x2)​IA (pneumococcal, hepatitis B), each additional vaccine Z23

 
Rationale

If counseling occurs outside of the IA service, there is no way to report it separately. Therefore, in this vignette, there is nothing separate to report during the well-child visit, and when the patient returns and sees the nurse only, pediatric IA codes cannot be reported; defer to codes 90471–90474. During the preventive medicine service, when an acute illness is detected, a code from 99212–99215 can be reported if the service is significant and separately identifiable. Code 9921x is reported with modifier 25. When the patient returns for vaccines only, an E/M service is not reported. The ICD-10-CM code will be reported for "with abnormal findings" (Z00.121) because an abnormality was identified during the encounter.

For more information on IA codes, refer to the Coding at the AAP Web site and its page dedicated to vaccine coding click here.

How to Code When Im​​munizations Are Not Administered

  • ​There are many reasons why immunizations are not given during routine preventive medicine services. Parents may refuse vaccines or defer them, a patient may be ill at the time and it is counteractive to administer, or the patient may already have had the disease or be immune.
  • Due to tracking purposes and quality measures, it is important to report non-administration as part of the ICD-10-CM codes. The following ICD-10-CM codes were created to report why a vaccine(s) is not given:

Vaccination not carried out due to

ICD-10-CM CodeDescriptor
​Z28.01Acute illness
Z28.02Chronic illness or condition
​Z28.03​Immunocompromised state
Z28.04​Allergy to vaccine or component
Z28.1​Religious reasons
Z28.20​Unspecified reason
Z28.21​Patient refusal
​Z28.81​Patient has disease being vaccinated against
​Z28.82​Caregiver refusal
​Z28.89​Other reason

Vignette
A 1-year-old presents for his routine well-child examination. He is scheduled to receive his first measles, mumps, rubella; hepatitis A; and varicella vaccines. Because he had a documented case of varicella when he was 9 months old, the varicella vaccine is not given.

Report the following ICD-10-CM codes linked to the E/M service:
Z23         Encounter for immunization
Z28.81    Vaccination not carried out due to patient had disease being vaccinated against

Vaccines for Children (VFC) Program

The rules for reporting vaccines for those patients who qualify for the Vaccines for Children (VFC) program will vary greatly. Some states require that the product code be submitted, while others require the IA codes. Some require the use of modifiers, while others do not. Currently the VFC program does not recognize component-based vaccine counseling; therefore, you will not be paid for CPT® code 90461. The American Academy of Pediatrics continues to work on changing this so that pediatric providers can be properly compensated for giving multiple-component vaccines. 

Commonly Administered Pediatric Vaccines              

CPT® Code  Separately report the administration with codes 90460–9046​​1 or 90471–90474. ​manufacturer Brand​ Components
90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, for intramuscular useNovartis Bexsero 1 
90621 Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, for intramuscular use
Pfizer Trumenba 1  
90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for intradermal use
 Sanofi Pasteur Fluzone
Intradermal Quad
1 
90633 Hepatitis A vaccine, pediatric/adolescent dosage, 2 dose, for intramuscular useGlaxoSmithKline
Merck
HAVRIX
VAQTA
1 
90644 Meningococcal conjugate vaccine, serogroups C & Y, and Haemophilus influenzae B vaccine (MenCY-Hib), 4-dose schedule, when administered to children 6 weeks–18 months of age, for intramuscular useGlaxoSmithKline MenHibrix 2 
90647 Haemophilus influenzae B vaccine (Hib), PRP-OMP conjugate, 3 dose, for intramuscular use Merck PedvaxHIB 1 
90648 Haemophilus influenzae B vaccine (Hib), PRP-T conjugate, 4 dose, for intramuscular useSanofi Pasteur
GlaxoSmithKline
ActHIB
HIBERIX
1 
90649 Human Papillomavirus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular useMerck GARDASIL 1 
90650 Human Papillomavirus (HPV) vaccine, types 16 and  18, bivalent, 3 dose schedule, for intramuscular use GlaxoSmithKline CERVARIX 1 
90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV), 3 dose schedule, for intramuscular use Merck Gardasil 9 1 
90655 Influenza virus vaccine, trivalent, split virus, preservative free, for children 6-35 months of age, for intramuscular useSanofi Pasteur Fluzone No Preservative Pediatric1 
90656 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to 3 years of age and above, for intramuscular useMerck
Sanofi Pasteur

Novartis
GlaxoSmithKline
GlaxoSmithKline
Afluria
Fluzone No Preservative
Fluvirin
FLUARIX
FLULAVAL
1 
 90657Influenza virus vaccine, trivalent, split virus, 6-35 months dosage, for intramuscular useSanofi PasteurFluzone​
1

90658​Influenza virus vaccine, trivalent, split virus, 3 years and older dosage, for intramuscular use​Merch
GlaxoSmithKline
Sanofi Pasteur
Novartis
​Afluria
FLULAVAL
Fluzone
Fluvirin
​1
​​90670​Pneumococcal conjugate vaccine, 13 valent, for intramuscular use​Pfizer​PREVNAR 13​1
90672​Influenza virus vaccine, quadrivalent, live, intranasal use ​MedImmuneFlumist
Quadrivalent
​1
90680​Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use​Merck​RotaTeq​1
90681​Rotavirus vaccine, human, attenuated, 2 dose schedule, live for oral use​GlaxoSmithKline​ROTARIX​1
90685​Influenza virus vaccine, quadrivalent, split virus, preservative free, for children 6-35 months of age, for itnramuscular use​Sanofi Pasteur
​Fluzone
Quadrivalent
​1
​90686 ​Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to 3 years of age and above, for intramuscular use
​GlaxoSmithKline

Sanofi Pasteur
​FLUARIX
Quadrivalent
Fluzone
Quadrivalent
​1
90687​Influenza virus vaccine, quadrivalent, split virus, 6-35 months dosage, for intramuscular use​Sanofi Pasteur​Fluzone
Quadrivalent
​1
90688​Influenza virus vaccine, quadrivalent, split virus, 3 years and older dosage, for intramuscular use. ​GlaxoSmithKline
SanofiPasteur
​FLULAVAL
Fluzone
Quadrivalent
​1
90696​Diptheria, tetanus toxoids, and acellular pertussis vaccine and poliovirus vaccine, inactivated(DTaP-IPV), when administered to children 4 years through 6 years of age, for intramuscular use​GlaxoSmithKline​​KINRIX​4
90697​Diptheria, tetanus, toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, haemophilus influenza type b PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTap-IPV-Hib-HepB), for intramuscular use​**​**​6
90698​Diphteria, tetanus toxoids, acellular pertussis vaccine, haemophilus influenzae type b, PRP-OMP conjugate vaccine, and hepatitus B vaccine (DTaP-Hib-IPV), for intramuscular use​Sanofi Pasteur​Pentacel​5
90700​Diphtehria, tetanux toxoid, and acellular pertussis vaccine (DTaP), when administered to younger than seven years, for intramuscular use​Sanofi Pasteur
GlaxoSmithKline
​DAPTACEL INFANRIX​3
90702​Diphtheria and tetanus toxoids (DT​Sanofi PasteurDiptheria and Tetanus Toxoids Adsorbed​​2
90707​Measles, mumps, and rubella virus vaccine (MMR), live, for subcutaneous use​Merck​M-M-R II3​
90710​Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use​Merck​ProQuad​4
90713​Poliovirus vaccine (IPV), inactivated, for subcutaneous or intramuscular use​Sanofi Pasteur​IPOL​1
90714​Tetanus and diptheria toxoids (Td) adsorbed, preservative free, when administered to seven years or older, for intramuscular use​
Sanofi PasteurTENIVAC​2
​90715​Diphtheria, tetanus toxoids, and accellular pertussis vaccine (Tday), when administered to 7 years or older, for intramuscular use​​Sanofi Pasteur
GlaxoSmitheKline
​ADACEL
BOOSTRIX
​3
90716Varicella cirus vaccine, live, for subcutaneous use​Merck​VARIVAX​1
90723​Diptheria, tetanus toxoids, accellular pertussis vaccine, hepatitis B, and poliovirus vaccine (DTaP-Hep B-IPV), for intramuscular use
GlaxoSmithKline
​​PEDIARIX5
90732​Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to 2 years or older, for subcutaneous or intramuscular use​MERCK​PNEUMOVAX 231​
90733​Meningococcal Polysaccharide vaccine, for subcutaneous use​Sanofi Pasteur​Menomune​1
90734​Meningococcal conjugate vaccine, serogroups A, C, Y, and W-135 (tetravalent), for intramuscular use​Sanofi Pasteur
Novartis
​Menactra
Menoeo
​1
90740​Hepatits B vaccine, dialysis or immunosuppresed patient dosage, 3 dose, for intramuscular use.​Merck​RECOMBIVAX HB​1
90743​Hepatitis B Vaccine, Adolescent, 2 dose, for intramuscular use​Merck​RECOMBIVAX HB​1
90744​Hepatits B, pediatric/adolescent, 2 dose, for intramuscular use​Merch​​RECOMBIVAX HC 
ENERGIX-B
​1
​90746​Hepattis B vaccine, adult dosage, for intramuscular use​Merck
GlaxoSmithKline
RECOMBIVAX HB 
ENERGIX-B
​1
90747​Hepatitis B vaccine, dialysis or immunosuppressed patient dosage, 4 dose, for intramuscular use​GlaxoSmithKline​ENERGIX=B​1
90748​Hepatitis B and Hib (Hep B-Hib), for intramuscular use​Merck​COMVAX​2
90749Unlisted Vaccine or toxoid
​​​​​ ​ ​ ​ ​** Vaccine pending US Food and Drug Administration approval (www.ama-assn.org//ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt/about/category-i-vaccine-codes.page).
Developed and maintained by the American Academy of Pediatrics. Updated periodically at https://www.aap.org/en-us/professiona-resources/practice-support/Coding-at-the-AAP/Documents/Vaccine Coding Table.pdf. For reporting purposes only. 


Healthcare Common Procedure Coding System Codes
  • HCPCS Level II codes are procedure codes used to report services and supplies not included in the CPT® nomenclature.
  • Like CPT codes, HCPCS Level II codes are part of the standard procedure code set under the Health Insurance Portability and Accountability Act of 1996.
  • Certain payers may require that HCPCS codes be reported in lieu of or as a supplement to CPT codes.
  • The HCPCS nomenclature contains many codes for reporting nonphysician provider patient education, which can be an integral service in the provision of pediatric preventive care.

Examples of HCPCS Level II codes relevant to pediatric preventive care include

S0302Completed Early and Periodic Screening, Diagnosis, and Treatment service (List in addition to code for appropriate E/M service.)
S0610Annual gynecologic examination; new patient
S0612Annual gynecologic examination; established patient
S0613Annual gynecologic examination, clinical breast examination without pelvic examination
S0622Routine examination for college, new or established patient (List separately in addition to appropriate E/M code.)
S9444Parenting classes, nonphysician provider, per session
S9445Patient education, not other​wise classified, nonphysician provider, individual, per session
S9446Patient education, not otherwise classified, nonphysician provider, group, per session
S9447Infant safety (including cardiopulmonary resuscitation) classes, nonphysician provider, per session
S9451Exercise classes, nonphysician provider, per session
S9452Nutrition classes, nonphysician provider, per session
S9454Stress management classes, nonphysician provider, per session
 

Laboratory Co​​des

​There are 2 different practice models surrounding the conducting of laboratory tests: blood is drawn in office and specimen is sent to an outside laboratory for analysis, or blood is drawn and laboratory tests are performed in the physician's practice. Never report the laboratory code for a laboratory test that the practice does not run in-house or is not financially responsible for and billed by the outside laboratory. In those cases, only report the blood draw and specimen handling as appropriate.


Model 1: Blood is drawn in office and specimen is sent to an outside laboratory for analysis
99000 Handling and/or conveyance of specimen for transfer from the physician’s office to a laboratory

Venipuncture

CPT Codes
36406Venipuncture, younger than 3 years, necessitating physician’s skill, not to be used for routine venipuncture
36410Venipuncture, 3 years or older, necessitating physician’s skill, for diagnostic or therapeutic purposes (not be used for routine venipuncture)​
36415Collection of venous blood by venipuncture
36416Collection of capillary blood specimen (eg, finger, heel, ear stick)
 
ICD-10-CM Codes
Link to ICD-10-CM code(s) for specific screening test(s).

Model 2: Blood is drawn and laboratory tests are performed in the physician’s practice

Venipuncture
CPT Codes
36406Venipuncture, younger than 3 years, necessitating physician’s skill, not to be used for routine venipuncture
36410Venipuncture, 3 years or older, necessitating physician’s skill, for diagnostic or therapeutic purposes (not be used for routine venipuncture)
36415Collection​ of venous blood by venipuncture
36416Collection of capillary blood specimen (eg, finger, heel, ear stick)
 
ICD-10-CM Codes
Link to ICD-9-CM code(s) for specific screening test(s).

Cholesterol Screening

CPT Codes
80061 Lipid panel (includes total cholesterol, high-density lipoprotein cholesterol, and triglycerides)
82465Cholesterol, serum, total
83718Lipoprotein, d​irect measurement, high-density cholesterol (HDL cholesterol)
84478Triglycerides
 
ICD-10-CM Codes
Z13.220Encounter for screening for lipid disorders​
 
Hematocrit/Hemoglobin

CPT Codes
85014 Blood count; hematocrit
85018Blood count; hemoglobin
 
ICD-10-CM Codes
Z13.0​Encounter for screening for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (eg, anemia)
 
Lead Screening

CPT Code
83655 Lead

ICD-10-CM Code
Z13.88​Encounter for screening for disorder due to exposure to contaiminants
 
Newborn Metabolic Screening

HCPCS Code
(NOTE: See “Healthcare Common Procedure Coding System Codes” section for explanation of HCPCS codes.)
S3620 Newborn metabolic screening panel, includes test kit, postage, and the laboratory tests specified by the state for inclusion in this panel (eg, galactose; hemoglobin, electrophoresis; hydroxyprogesterone, 17-D; phenylalanine(PKU); and thyroxine, total)
 
ICD-10-CM Codes
Report the diagnosis code(s) for the state-specific newborn screening test(s) conducted. Examples include
Z13.0Encounter for screening for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (eg, anemia, sickle cell)
Z13.21Encounter for screening for nutritional disorder
Z13.228Encounte​r for screening for other metabolic disorders (eg, PKU, galactosemia)
Z13.29Encounter for screening for other suspencted endocrine disorder (eg, thyroid)
 
Papanicolaou Smear

HCPCS Code
(NOTE: See “Healthcare Common Procedure Coding System Codes” section for explanation of HCPCS codes.)
Q0091 Screening Papanicolaou smear; obtaining, preparing, and conveyance of cervical or vaginal smear to laboratory
 
CPT Code
Collection of a cervical specimen via a pelvic examination is included in the preventive medicine service code (9938199385 and 99391-99395).

ICD-10-CM Codes
Z12.4Encounter for screening for malignant neoplasm of cervix (excludes HPV)​
Z12.72​Encounter fo​r screening for malignant neoplasm of vagina
Z12.79​Encounter for screening for malignant neoplasm of other genitourinary organs
Z12.89​Encou​nter for screening for malignant neoplasms of other sites
 
Tuberculosis Testing (Mantoux/Purified Protein Derivative)

Administration of Purified Protein Derivative Test
CPT CodeICD-10-CM Code
86580 Skin test; tuberculosis, intradermal

Z11.1  Encounter for screening for respiratory tuberculosis

 
NOTE: There is no separate administration code for the PPD. Do not report one.

Reading of Purified Protein Derivative Test
If patient returns to have a nurse read the test results, report
CPT Code ICD-10-CM Code
99211 Office or other outpatient services(nurse visit)Z11.1  Encounter for screening for respiratory tuberculosis
​​​or

R76.11 Nonspecific reaction to tuberculin skin test without active tuberculosis (if test is positive) 

Sexually Transmitted Infection Screening

CPT Codes
86701Antibody; HIV-1
86703Antibody; HIV-1 and HIV-2; single assay
87490Infectious agent detection by nucleic acid (DNA or RNA); C trachomatis, direct probe technique
87491Infectious agent ​detection by nucleic acid (DNA or RNA); C trachomatis, amplified probe technique
87590Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique
87591Infectious agent detection by nucleic acid (DNA or RNA); N gonorrhoeae, amplified probe technique
87810Infectious agent detection by immunoassay with direct optical observation; C trachomatis
87850Infectious agent detection by immunoassay with direct optical observation; N gonorrhoeae
 
ICD-10-CM Codes
​Z11.3Encounter for screening for infections with a predominantly sexual mode of transmission (excludes HPV and HIV)
​Z11.8​​Encounter for s​creening for other infectious and parasitic diseases (eg, chlamydia)
 
         

Commonly Reported ICD-10-CM Codes for Preventive Services

ICD-10-CM Code​a​Descriptor​Special Coding Conventions
Z00.110Newborn check under 8 days old​Outpatient codes only 
Z00.111Newborn check 8 to 28 days old​Outpatient codes only
Z00.121

Z00.129
Routine child health examination with abnormal findings

Routine child health examination without abnormal findings
​First-listed ICD-10-CM code only. Includes routine screening when performed at same encounter
Z00.00


Z00.01
General adult medical examination without abnormal findings
General adult medical examination with abnormal findings
​First-listed ICD-10-CM code only. Typically used for patients 18 years and older (payer policy)

Z02.0

Z02.4

Z02.5

Examination for admission to educational institution

Examination for driving license

Examination for participation in sport

​Not required in addition to a Z00 code.

Z01.00

Z01.01

Examination of eyes and vision without abnormal findings

Examination of eyes and vision with other abnormal findings
​First-listed ICD-10-CM code only. Do not report as a secondary code or in addition to a Z00 code.
Z01.110Hearing examination following failed hearing screening​First-listed ICD-10-CM-code only. Do not report as a secondary code or in addition to a Z00 code. 

Z01.10

Z01.118

Encounter for examination of ears and hearing without abnormal findings

with other abnoraml findings

​First-listed ICD-10-CM-code only. Do not report as a secondary code or in addition to a Z00 code. 
Z23Immunizations​This is the only code in ICD-e0-CM for vaccines. Link to both the product and administration CPT codes. 
​Screening Codes
Z11.1​Respiratory tuberculosis​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 
Z11.3​Infections with a predominantly sexual mode of transmission (excludes HPV and HIV)A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 

Z12.4

Encounter for screening for malignant neoplasm of cervix (excludes HPV)​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 

Z12.79

Z12.89

Malignant neoplasm of other genitourinary organs

Malignant neoplasms of other sites

​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 
Z13.29Other suspected endocrine disorder​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 
Z13.1Diabetes mellitus​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 
Z13.228​Other metabolic disorders (eg, inborn errors of metabolism, galactosemia, PKU)​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 

Z13.220

Lipoid disorders​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 

Z13.21

Z13.228

Z13.29

Nutritional disorder

Other metabolic disorder

Other suspected endocrine disorder

​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 

Z13.0

​Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (eg, anemia, sickle cell)

​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 

Z13.89

Other disorders (eg, depression)

​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 

Z13.4

Developmental disorders in childhood (excludes routine screening) (eg, Autism)​Do not report in addition to a Z00.12 - Code; it is already included

Z13.88

Disorder due to exposure to contaminants (eg, lead)

​A screening code is not necessary if the screening is inherent to a routine examindation. But can be reported. 
​​​ ​Underimmunized Status and Vaccines Not Given
Z28.3Underimmunized status​A status code is informative and may affect the course of treatment and its outcome. report when this is the case. 
Z28.01Vaccine not given: Acude illness
Z28.04     ​Allergy to vaccine or components
Z28.82​     Caregiver Refusal
Z28.02​     Chronic illness or condition
Z28.03​     Immune compromised state
Z28.21​     Patient refusal
Z28.81​     Pt had disease being vaccinated for
Z28.1​     Religious reasons
Z28.89​     Other reason
Z28.20​     Unspecified reason

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