ICD-10-CM Immunization Codes
Chapter 21 contains ICD-10-CM immunization codes, routine health exams, and common preventive screenings. These are the ICD-10 Z codes: Factors influencing health status and contact with health services, found in chapter 21 in the code book. For some encounters and services, ICD-10 offers fewer codes. Examples of these are codes related to preventive services. Although the ICD-10-CM immunization codes as well as other preventive service codes are straightforward, coding can still be complicated because of the Affordable Care Act (ACA).
The combination of CPT/HCPCS and ICD-10 codes should be coded properly in order to obtain insurance payments for preventive services covered under the Affordable Care Act. ICD-10 recognizes the type of vaccine reported with a CPT or HCPCS code which gives sufficient detail about the type of immunization the patient needs. So rather than having provide individual diagnosis codes for each vaccine, ICD-10 allows you to report code Z23 for an encounter involving immunization regardless of the type or number of vaccines. This is advantageous in cases when reporting multiple childhood immunizations. In ICD-10-CM, the diagnosis code used for reporting administration of an immunization or vaccination is Z23, Encounter for immunization. Information on the specific immunization administered is provided by the procedure code. For example, if CPT code 90655 is reported with Z23 it would indicate that a split virus intramuscular influenza vaccine was administered to a child between 6 and 35 months of age.
ICD-10-CM immunization codes Z23 applies to all vaccinations
This code is used for the description below:
- Bacterial disease vaccination given
- Bacterial disease vaccination given (situation)
- Diphtheria and tetanus vaccination given
- Diphtheria and tetanus vaccination given (situation)
- Diphtheria, tetanus and acellular pertussis vaccination given
- Diphtheria, tetanus and acellular pertussis vaccination given (situation)
- Diphtheria, tetanus, acellular pertussis, haemophilus influenzae B and inactivated polio vaccinations given
- Diphtheria, tetanus, acellular pertussis, haemophilus influenzae B and inactivated polio vaccinations given (situation)
- Diphtheria, tetanus, acellular pertussis, hepatitis B and inactivated polio vaccinations given
- Diphtheria, tetanus, acellular pertussis, hepatitis B and inactivated polio vaccinations given (situation)
- Diphtheria, tetanus, pertussis and polio vaccination given
- Diphtheria, tetanus, pertussis and polio vaccination given (situation)
- Haemophilus influenzae type b vaccination
- Haemophilus influenzae type b vaccination (procedure)
- Herpes zoster vaccination given
- Herpes zoster vaccination given (situation)
- Human papilloma virus vaccination given
- Human papilloma virus vaccination given (situation)
- Influenza vaccination given
- Influenza vaccination given (situation)
- Measles, mumps and rubella vaccination given
- Measles, mumps and rubella vaccination given (situation)
- Meningococcal vaccination given
- Meningococcal vaccination given (situation)
- Pneumococcal 13-valent conjugate vaccination given
- Pneumococcal 13-valent conjugate vaccination given (situation)
- Pneumococcal 23-valent polysaccharide vaccination given
- Pneumococcal 23-valent polysaccharide vaccination given (situation)
- Vaccination for bacterial disease
- Vaccination for diphtheria, tetanus and acellular pertussis
- Vaccination for diphtheria, tetanus and acellular pertussis (DTaP)
- Vaccination for diphtheria, tetanus, acellular pertussis, haemophilus influenzae type B and polio
- Vaccination for diphtheria, tetanus, pertussis, and polio
- Vaccination for haemophilus influenzae type B
- Vaccination for herpes zoster
- Vaccination for HPV
- Vaccination for human papilloma virus (HPV)
- Vaccination for influenza
- Vaccination for measles, mumps and rubella
- Vaccination for measles, mumps and rubella (MMR)
- Vaccination for meningococcus
- Vaccination for strep pneumonia w pneumovax
- Vaccination for strep pneumonia w Prevnar 13
- Vaccination for Streptococcus pneumoniae with pneumovax
- Vaccination for Streptococcus pneumoniae with Prevnar 13
- Vaccination for tetanus and diphtheria
- Vaccination for tetanus, diphtheria, acellular pertussis, hepatitis B and polio
- Vaccination for varicella
- Vaccination for varicella (chicken pox)
- Vaccination for viral hepatitis
- Vaccination for yellow fever
- Vaccination w combination vaccine
- Vaccination with combination vaccine
- Vaccination with combination vaccine done
- Vaccination with combination vaccine done (situation)
- Varicella vaccination
- Varicella vaccination (procedure)
- Viral hepatitis vaccination given
- Viral hepatitis vaccination given (situation)
- Yellow fever vaccination given
- Yellow fever vaccination given (situation)
Unlike in CPT, the PCS procedure codes are not specific as to the type of toxoid or vaccine that is being administered. A code for any routine childhood examination should be coded first according to the “ICD-10-CM Guidelines for code Z23 and procedure codes are required to identify the types of immunization.
Another example to explain the immunization coding in ICD-10-CM is:
In CPT,
- DTaP administered to a 5-year-old child would be coded as 90700 Diphtheria, Tetanus toxoids, and Acellular Pertussis vaccine (DTaP);
- When administered to a child who is younger than seven years, for intramuscular use, it is coded to 90471 Immunization administration including percutaneous, subcutaneous, intramuscular, or jet injections. This is for one vaccine which is single or combination vaccine/toxoid type.
The PCS code is different for DTaP which is 3E0234Z.
This code refers to the body system or the region for intramuscular administration but does not capture the specific drug.
ICD-10 Immunization Codes have simplified the preventive care coding by offering a fewer number of codes to choose from.