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Tips for Reporting Vaccinations
Vaccines Administered at Well-Child Visits
When vaccines are provided as part of a well-child encounter, the ICD-9 guidelines instruct that code V20.2 (Routine infant or child health check) includes immunizations appropriate to the patient's age. A code from categories V03-V06 may be used as a secondary code if the vaccine is given as part of a preventive health care service, such as a well-child visit.
ICD-9 for Combination Vaccines
When reporting ICD-9 codes for prophylactic vaccination and inoculation against combinations of diseases, use V06.0-V06.9; report also single vaccination codes from V03-V05 for any vaccinations not included in the combination code.
E/M Services Provided on the Same Date as Vaccine Administration
When an evaluation and management service (other than a preventive medicine service) is provided on the same date as a prophylactic immunization, modifier -25 may be appended to the code for the evaluation and management service to indicate that this service was significant and separately identifiable from the physician's work of the vaccine counseling/administration.
Example: A patient presents for a visit to evaluate the control of his/her diabetes and at the same visit receives an influenza vaccine administration. A physician might report code 99213-25 with diagnosis code 250.00 in addition to the appropriate flu vaccine and administration codes.
Example: A patient presents for a visit to evaluate the control of his/her diabetes and at the same visit receives an influenza vaccine administration. A physician might report code 99213-25 with diagnosis code 250.00 in addition to the appropriate flu vaccine and administration codes.
Adding National Drug Codes (NDC) to Claims
Medicaid plans and private payers may require the inclusion of a vaccine product's National Drug Code (NDC) on your claim line for each vaccine product. This can be a bit confusing if the product is labeled with a 10-digit NDC, as HIPAA requires that NDC have 11-digits. To correctly report the NDC in the HIPPA format, you may have to translate the NDC.
The common format for submitting an NDC is a number that, if hyphenated, would appear in a 5-4-2 format. Some drug products are labeled in 4-4-2, 5-3-2, or 5-4-1 formats. To change these codes to the 11-digit format, a zero is placed within the product code to create the 5-4-2 format.
Here are some examples showing addition of a zero to create this format:
The common format for submitting an NDC is a number that, if hyphenated, would appear in a 5-4-2 format. Some drug products are labeled in 4-4-2, 5-3-2, or 5-4-1 formats. To change these codes to the 11-digit format, a zero is placed within the product code to create the 5-4-2 format.
Here are some examples showing addition of a zero to create this format:
| 10-digit NDC | 11-digit NDC |
| 4444-4444-22 | 04444-4444-22 |
| 55555-333-22 | 55555-0333-22 |
| 55555-4444-1 | 55555-4444-01 |
This information is not required by all payers.
Coding for Vaccines and Administration
