The Centers for Medicare and Medicaid Services (CMS) has provided new guidance for institutional providers for coding claims for vaccine administration when the vaccination is the only service billed on the claim, according to the agency.

In a blog post highlighting the development, Dan Ciolek, associate vice president, therapy advocacy, American Health Care Association, said the effective date is for claims with a date of service starting just this past April 13. 

Below is the modified CMS guidance. The new coding requirements are in the bold and italicized text, Ciolek said: 

“The following diagnosis code must be reported. If the sole purpose for the visit is to receive a vaccine or if a vaccine is the only service billed on a claim, the applicable following diagnosis code may be used.  

• ICD-10-CM Diagnosis Code = Z23 -- Description - Encounter for Immunization  

NOTE: ICD-10-CM diagnosis code Z23 is to be used for all encounters for preventive vaccine immunizations, including COVID-19 immunizations.  

The following condition code must be reported on institutional claims when diagnosis code Z23 is required for a vaccination.  

Condition Code = A6 -- Description - Vaccine / Medicare 100% Payment  

All claims must have the appropriate diagnosis code, procedure, and admin code to process correctly.”   

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com.