CODING & DOCUMENTATION
Fam Pract Manag. 2017 Nov-Dec;24(6):34.
Author disclosure: no relevant financial affiliations disclosed.
Which ICD-10 code should I assign to indicate a patient's immunization refusal?
If a patient refuses immunization due to religious belief or group pressure, assign code Z28.1, “Immunization not carried out because of patient decision for reasons of belief or group pressure.” If the patient refuses for another reason, such as the discomfort of injections, report code Z28.21, “Immunization not carried out because of patient refusal.” When a parent or other caregiver refuses immunization for a child, report code Z28.82, “Immunization not carried out because of caregiver refusal.”
CPT codes 99381 – 99397 for initial or periodic comprehensive preventive medicine visits include all counseling, anticipatory guidance, and risk-factor reduction interventions provided at the time of the exam. Note that immunization counseling not provided in conjunction with a preventive medicine exam and taking at least eight minutes may be reported with preventive medicine counseling and risk-factor reduction codes 99401 – 99404. Preventive medicine counseling codes may be reported alone or in conjunction with a code for a significant, separately identifiable E/M service, to which you would append modifier 25.
For quality measurement, payers may require reporting HCPCS code G8483 when a flu shot is not administered for reasons documented by the clinician.
Care planning and chronic care management
Can we bill HCPCS code G0506, “Comprehensive assessment of and care planning for patients requiring chronic care management services,” in the same 30-day period as chronic care management (CCM) codes 99490, 99487, and 99489?
Yes. G0506 is an add-on code that may be reported in addition to the code for an initiating visit when the billing provider personally performs assessment and care planning beyond the usual effort of the initiating visit. Initiating visits
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