Coding for Pediatric Preventive Care

CODING FOR

Pediatric

Preventive

Care

2022

Coding for Pediatric Preventive Care, 2022

is 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 or billing sheet.

Following are the Current Procedural Terminology (CPT®), Healthcare

Common Procedure Coding System (HCPCS) Level II, and International

Classication of Diseases, 10th Revision, Clinical Modication (ICD-10-CM)

codes most commonly reported by pediatricians in providing preventive

care services. e pediatrician, not the sta, is ultimately responsible for

the appropriate codes to report.

SYMBOL DESCRIPTION

•

A bullet at the beginning of a code means it is a new code for the current year.

+ A plus sign means the code is an add-on code.

~~ A lightning bolt indicates that a vaccine product code was approved, but the

vaccine product is still pending FDA approval.

The recommendations

in this publication do not indicate an exclusive course of treatment or

serve as a standard of medical care. Variations, taking into account individual circumstances,

may be appropriate.

transmitted in any form or by any means—electronic, mechanical, photocopying, recording, or

otherwise—without prior written permission from the publisher.

Printed in the United States of America

Current Procedural Terminology (CPT®) 5-digit codes, nomenclature, and other data are copyright

relative values, or related listings are included in CPT. The AMA assumes no liability for the

data contained herein.

The Bright Futures/American Academy of Pediatrics “Recommendations for Preventive Pediatric

Health Care,” also known as the “periodicity schedule,” is a schedule of screenings and assessments

recommended at each well-child visit from infancy through adolescence. The following services

and codes coincide with this schedule. For more details on the periodicity schedule, see

https://www.aap.org/en/practice-management/care-delivery-approaches/periodicity-schedule/.

PREVENTIVE MEDICINE SERVICE CODES

Services included under these codes include measurements (eg, length/

height, head circumference, weight, body mass index, blood pressure)

and age- and gender-appropriate examination and history (initial or

interval).

▶ Preventive medicine service codes are not time-based; therefore, time

spent during the visit is not relevant in selecting the appropriate

preventive medicine service code.

▶ If an illness or abnormality is discovered, or a preexisting problem

is addressed, in the process of performing the preventive medicine

service, and if the illness, abnormality, or problem is signicant

enough to require additional work to perform the components

of a problem-oriented evaluation and management (E/M) service

(ie, using medical decision making or time spent), the appropriate

oce or other outpatient service code (99202–99215) should be

reported in addition to the preventive medicine service code.

Append modier 25 to the oce or other outpatient service

code (eg, 99392 and 99213 25).

▶ An insignicant or trivial illness, abnormality, or problem encountered

in the process of performing the preventive medicine service should

not be separately reported.

▶ e comprehensive nature of the preventive medicine service

codes reects 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).

▶ Immunization products and administration and ancillary studies

involving laboratory, radiology, or other procedures, or screening

tests (eg, vision, developmental, hearing) identied with a specic

CPT

code, are reported and paid for separately from the preventive

medicine service code.

▶ For more information on coding during the COVID-19 pandemic

(including telemedicine and telehealth), refer to the AAP's coding

site (www.aap.org/coding) and its page dedicated to this coding.

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 interven-

tions; and the ordering of laboratory or diagnostic procedures.

▶ A new patient is dened as one who has not received any professional

face-to-face services rendered by physicians and other qualied health

care professionals (QHPs) who may report E/M services and reported

by a specic CPT code(s) from a physician/other QHP, or another

physician/other QHP of the exact same specialty and subspecialty

who belongs to the same group practice, within the past 3 years.

CPT Codes ICD-10-CM Codes

99381 Infant (younger than 1 year) Z00.110 Health supervision for newborn

under 8 days old or

Z00.111 Health supervision for newborn

8 to 28 days old or

Z00.121 Routine child health exam

with abnormal ﬁndings or

Z00.129 Routine child health exam

without abnormal ﬁndings

99382 Early childhood (age 1–4 years)

99383 Late childhood (age 5–11 years)

99384 Adolescent (age 12–17 years)

Z00.121

Z00.129

99385 18 years or older Z00.00 General adult medical exam

without abnormal ﬁndings

Z00.01 General adult medical exam

with abnormal ﬁndings

Preventive Medicine Services: Established Patients

Periodic comprehensive preventive medicine reevaluation and manage-

ment 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

99391 Infant (younger than 1 year) Z00.110 Health supervision for newborn

under 8 days old or

Z00.111 Health supervision for newborn

8 to 28 days old or

Z00.121 Routine child health exam

with abnormal ﬁndings or

Z00.129 Routine child health exam

without abnormal ﬁndings

99392 Early childhood (age 1–4 years)

99393 Late childhood (age 5–11 years)

99394 Adolescent (age 12–17 years)

Z00.121

Z00.129

99395 18 years or older Z00.00 General adult medical exam

without abnormal ﬁndings

Z00.01 General adult medical exam

with abnormal ﬁndings

Preventive Medicine Services: With And Without Abnormal Findings

e use of an ICD-10-CM code for with abnormal ndings (eg, Z00.121)

does not mean that an additional E/M service must or can be used.

Abnormal ndings can be trivial or incidental issues that do not require

additional work, but the condition is still documented or listed as con-

tributory. Examples of abnormal ndings include abnormal screening

results, new acute problem, or unstable or worsening chronic condition.

A stable chronic condition (whether addressed or not) would not warrant

the use of an abnormal ndings code. You can link an abnormal ndings

ICD-10-CM code to a screening if the screen is normal; the abnormality

will be identied with the appropriate ICD-10-CM code so the payer will

be aware.

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.

▶ ey are distinct from other E/M services that may be reported

separately when performed. However, one exception is 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

according to 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 specic

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 oce or other outpatient service code (99202–

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, Counseling

CPT Codes

99401 Preventive medicine counseling or risk factor reduction

intervention(s) provided to an individual; approximately

15 minutes

99402 approximately 30 minutes

99403 approximately 45 minutes

99404 approximately 60 minutes

99411 Preventive medicine counseling or risk factor reduction

intervention(s) provided to individuals in a group setting;

approximately 30 minutes

99412 approximately 60 minutes

ICD-10-CM Codes for Preventive Counseling

▶ e diagnosis codes reported for preventive counseling will vary

depending on the reason for the encounter.

▶ Remember that the patient cannot have symptoms or established

illness; therefore, the diagnosis codes reported cannot reect

symptoms or illnesses.

▶ Examples of some possible diagnosis codes include

Z28.3

Underimmunized status (Code also reason patient is behind,

eg, Z28.82 [caregiver refusal])

Z71.3

Dietary surveillance and counseling

Z71.82 Exercise counseling

Z71.84 Encounter for health counseling related to travel

Z71.85 Encounter for immunization safety counseling (Code also if

vaccine is not carried out [eg, Z28.82])

Z71.89

Other specied counseling

Z71.9 Counseling, unspecied

Behavior Change Interventions, Individual

▶ Used only when counseling a patient (not parent) 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 eects (eg, illness), or include

under the problem-related E/M service if patient is present for a

sick visit (99202–99215).

▶ Codes 99406–99409 may be reported in addition to the preventive

medicine service codes.

CPT Codes

99406 Smoking and tobacco use cessation counseling visit;

intermediate, greater than 3 minutes up to 10 minutes

99407 intensive, greater than 10 minutes

99408 Alcohol or substance (other than tobacco) abuse structured

screening (eg, Alcohol Use Disorder Identication Test

[AUDIT], Drug Abuse Screening Test [DAST]) and brief

intervention (SBI) services; 15 to 30 minutes

99409 greater than 30 minutes

ICD-10-CM Codes for Risk Factor Reduction and Behavior Change

Interventions

F10.10 Alcohol abuse, uncomplicated

F11.10 Opioid abuse, uncomplicated

F12.10 Cannabis abuse, uncomplicated

F13.10 Sedative, hypnotic or anxiolytic abuse, uncomplicated

F13.90 Sedative, hypnotic, or anxiolytic use, unspecied, uncomplicated

F15.90 Other stimulant use, unspecied, uncomplicated

F16.90 Hallucinogen use, unspecied, uncomplicated

F17.290 Nicotine dependence, other tobacco products (Includes

Electronic nicotine delivery systems [ENDS]/vaping products)

Z71.41 Alcohol abuse counseling and surveillance of alcoholic

Z71.51 Drug abuse counseling and surveillance of drug abuser

Z71.6 Tobacco abuse counseling

Z87.891 Personal history of nicotine dependence

Z91.89 Other specied personal risk factors, presenting as hazards to

health not elsewhere classied

OTHER PREVENTIVE MEDICINE SERVICES

Oral Health

CPT Code

99188 Application of topical uoride varnish by a physician or other

qualied health care professional

Refer to page 15 for the denition of QHP.

ICD-10-CM Codes

Z00.121 Routine child health exam with abnormal ndings

Z00.129

Routine child health exam without abnormal ndings

Z29.3

Encounter for prophylactic uoride administration

Z91.841 Risk for dental caries, low

Z91.842 Risk for dental caries, moderate

Z91.843 Risk for dental caries, high

Z91.849 Unspecied risk for dental caries

Pelvic Examination

▶ Preventive medicine service codes (99381–99385 and 99391–99395)

include a pelvic examination as part of the age- and gender-appropriate

examination.

▶ If the patient is having a problem, the physician can report an oce

or other outpatient E/M service code (99212–99215) for the visit and

attach modier 25, which identies that the problem-oriented pelvic

visit is a separately identiable 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

examination with abnormal ndings (Z00.121 or Z00.01) to the

preventive medicine service code, but link a dierent diagnosis code

(eg, N89.8 [vaginal discharge], N94.4 [primary dysmenorrhea]) to

the oce or other outpatient E/M service code (eg, 99212).

▶ Anticipatory or periodic contraceptive management is not a “problem”

and is therefore 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 oce or other outpatient service code.

ICD-10-CM Codes

Z01.411 Gynecological exam with abnormal ndings

Z01.419

Gynecological exam without abnormal ndings

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 (IUD)

Z30.015 Encounter for initial prescription of vaginal ring hormonal

contraceptive

Z30.016 Encounter for initial prescription of transdermal patch

hormonal contraceptive device

Z30.017 Encounter for initial prescription of implantable subdermal

contraceptive

Z30.018 Encounter for initial prescription of other contraceptives

Z30.02 Counseling and instruction in natural family planning to

avoid pregnancy

Z30.09 General counseling and advice on contraception

Z30.40 Surveillance of contraceptives, unspecied

Z30.41 Surveillance of contraceptive pills

Z30.42 Surveillance of injectable contraceptive

Z30.430 Insertion of IUD

Z30.431 Routine checking of IUD

Z30.432 Removal of IUD

Z30.433 Removal and reinsertion of IUD

Z30.44 Encounter for surveillance of vaginal ring hormonal

contraceptive device

Z30.45 Encounter for surveillance of transdermal patch hormonal

contraceptive device

Z30.46 Encounter for surveillance of implantable subdermal

contraceptive

Z30.49 Surveillance of other contraceptives

Health Risk Assessments

CPT Codes

96160 Administration of patient-focused health risk assessment

instrument (eg, health hazard appraisal) with scoring and

documentation, per standardized instrument

96161 Administration of caregiver-focused health risk assessment in-

strument (eg, depression inventory) for the benet of the patient,

with scoring and documentation, per standardized instrument

NOTE: Code 96161 can be reported for a postpartum screening administered

to a mother as part of a routine newborn check but billed under the baby’s

name. Link to ICD-10-CM code Z00.121 or Z00.129 for normal screening

results during a routine well-baby examination. Do not report ICD-10-CM

code Z13.31 or Z13.32 under the baby, as those are only for the maternal

record. Alternatively, payers may require G0442 (Annual alcohol misuse

screening, 15 minutes) in lieu of 96160 if screening for alcohol use.

▶ Used to report administration of standardized

health risk assessment instru-

ments on the patient (96160) or a primary caregiver (eg, parent) on behalf of

the patient (96161). Code 96160 would be used to report a standardized

suicide risk assessment linked to ICD-10-CM code Z13.39 (Encounter for

screening examination for other mental health and behavioral disorders).

Code 96161 requires that the questions and answers relate to the primary

caregiver’s health and behaviors, not the patient’s. For standardized ques-

tionnaires about the family's environment (that includes the patient), report

code 96160.

▶ CPT defines standardization as, “Standardized instruments are validated tests

that are administered and scored in a consistent or ‘standard’ manner

consistent with their validation.”

▶ A non-standardized screen or assessment is not separately reported, unless a

specific payer allows.

▶ At the time of publication, the recommended Sudden Cardiac Arrest/Death

risk assessment was not standardized, therefore no separate CPT code can be

reported.

Unlisted Preventive Medicine Service

CPT Code

99429 Unlisted preventive medicine service

Report code 99429 only when a more specic preventive medicine service

code does not exist.

SCREENING CODES

Developmental/Autism Screening and Behavioral/Social/

Emotional Screening

CPT Codes ICD-10-CM Codes

96110 Developmental screening,

per instrument, scoring

and documentation

Z13.41 Encounter for autism screening

Z13.42 Encounter for screening for global

developmental delays (milestones)

96127 Brief emotional/behavioral

assessment (eg, depression

inventory) with scoring

and documentation, per

standardized instrument

Z13.31 Encounter for screening for

depression

Z13.39 Encounter for screening examination

for other mental health and

behavioral disorders

▶ U

sed to report administration of standardized developmental/autism

screening instruments (96110) or behavioral/social/emotional screening

instruments (96127). See page 10 for the definition of standardized.

▶ Often reported when performed in the context of preventive medicine

services but may also be reported when screening or assessment is

performed with other E/M services (eg, 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 screening 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) may need to be appended to the E/M code to show the E/M

service was distinct and necessary at the same visit.

▶ Alternatively, some payers may require the use of code G0444 (annual

depression screening, 15 minutes) in lieu of code 96127 for the routine

depression screening.

▶ For more information on reporting 96110 and 96127 instruments, refer to

https://downloads.aap.org/AAP/PDF/coding_factsheet_

developmentalscreeningtestingandEmotionalBehvioraassessment.pdf.

Hearing Screening

CPT Codes ICD-10-CM Codes

92551 Screening test, pure tone,

air only

Z00.121 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)

▶ 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 modier 52 when a test is applied

to only one ear.

▶ For newborn hearing screenings for young patients, including those

patients who are nonverbal or have developmental delays, other hearing

assessment methods may be more appropriate.

CPT Codes ICD-10-CM Codes

92558 Evoked otoacoustic emissions,

screening (qualitative measurement

of distortion product or transient

evoked otoacoustic emissions),

automated analysis

Z00.110 Health supervision for

newborn under 8 days old

Z00.111 Health supervision for

newborn 8 to 28 days old

Z00.121 Routine child health exam

with abnormal ﬁndings

Z00.129 Routine child health exam

without abnormal ﬁndings

P09.6 Abnormal ﬁndings on

neonatal screening

92650 Auditory evoked potentials;

screening of auditory potential with

broadband stimuli, automated

analysis

92587 Distortion product evoked

otoacoustic emissions; limited

evaluation (to conﬁrm the presence

or absence of hearing disorder, 3-6

frequencies) or transient evoked

otoacoustic emissions, with

interpretation and report

92588 comprehensive diagnostic

evaluation, with interpretation

and report

▶ Codes Z01.10 (encounter for examination of ears and hearing without

abnormal ndings) and Z01.118 (encounter for examination of earsand

hearing with other abnormal ndings) are reported only when a patient

presents for an encounter specic to ears and hearing, not for a routine

well-child examination at which a hearing screening is performed.

▶ Failed hearing screenings will most likely result in a follow-up oce

visit (eg, 99212–99215). Code Z01.110 (encounter for hearing exami-

nation following failed hearing screening) is reported when a specic

disorder cannot be identied or when the follow-up hearing screening

ndings are normal. You can also report Z01.118 (encounter for exam-

ination of ears and hearing with other abnormal ndings) and include

the code for the abnormal ndings (eg, R94.120 [abnormal auditory

function study]).

Vision Screening

CPT Codes ICD-10-CM Codes

99173 Screening test of visual acuity

quantitative, bilateral

Z01.020 Encounter for examination of eyes

and vision following failed vision

screening without abnormal

ﬁndings

Z01.021 Encounter for examination of eyes

and vision following failed vision

screening with abnormal ﬁndings

Z00.121 Routine child health exam

with abnormal ﬁndings

99174 Instrument-based ocular

screening (eg, photoscreening,

automated-refraction), bilateral,

with remote-analysis and report

Z00.129 Routine child health exam

without abnormal ﬁndings

99177 Instrument-based ocular

screening (eg, photoscreening,

automated-refraction), bilateral,

with on-site analysis

Z01.00 and Z01.01 (examination of eyes and vision with and without

abnormal ndings) are reported only for routine examination of eyes and

vision, not when a vision screening is done during a routine well-child

examination.

▶ 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 or 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 oce or

other outpatient service code (99202–99215) and is not reported

separately.

▶ Other identiable services unrelated to the screening test provided

at the same time are reported separately (eg, preventive medicine

services).

▶ Failed vision screenings will most likely result in a follow-up oce

visit (eg, 99212–99215). Report the follow-up screening with

Z01.020 (encounter for examination of eyes and vision following

failed vision screening without abnormal ndings) if normal results

or Z01.021 (encounter for examination of eyes and vision following

failed vision screening with abnormal ndings) if abnormal results.

If abnormal, link to the diagnosis code for the reason for the failure

(eg, H52.1- [myopia]); when a specic disorder cannot be identied,

report R94.118 (abnormal results of other function studies of eye).

IMMUNIZATIONS

Immunization Administration (IA)

Pediatric IA Codes

90460 Immunization administration (IA) through 18 years of age

via any route of administration, with counseling by physician

or other qualied health care professional; rst or only

component of each vaccine or toxoid administered

+90461 each additional vaccine or toxoid component

administered (List separately in addition to code for

primary procedure.)

Report 90461 in conjunction with 90460.

▶ Component refers to all antigens in a vaccine that prevent diseases

caused by 1 organism. Multivalent antigens or multiple serotypes of

antigens against a single organism are considered a single component

of vaccines. Combination vaccines are vaccines that contain multiple

vaccine components. Conjugates or adjuvants contained in vaccines

are not considered to be component parts of the vaccine, as dened

previously.

▶ A QHP 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 to independently report a professional service. ese

professionals are distinct from clinical sta. A clinical sta member

is a person who works under the supervision of a physician or other

QHP and who is allowed by law, regulation, facility, and payer policy

to perform or assist in the performance of specied professional

services but does not individually report any professional services.

▶ Code 90460 is used to report the rst or only component in a single

vaccine given during an encounter. You can report 90460 more than

once during a single oce encounter. Code 90461 is considered an

add-on code to 90460 (hence the + symbol next to it). is means

that the provider will use 90461 in addition to 90460 if more than

1 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. e patient must be 18 years or younger.

2. e physician or other QHP must perform face-to-face vaccine

counseling associated with the administration.

NOTE: e clinical sta can do the actual administration of the vaccine.

▶ If both of these requirements are not met, report a non–age-specic

IA code (90471–90474) instead.

Non–age-speciﬁc IA Codes

▶ Report a CPT code for both the administration and product and an

ICD-10-CM code for each vaccine administered during a patient

encounter.

90471 IA (includes percutaneous, intradermal, subcutaneous, or

intramuscular injections); one vaccine (single or combination

vaccine/toxoid)

Do not report 90471 in 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.

90473 IA (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 rst immunization

given during a single oce visit. Codes 90472 and 90474 are con-

sidered add-on codes (hence the + symbol next to them) to 90460,

90471, and 90473. is means that the provider will use 90472 or

90474 in addition to 90460, 90471, or 90473 if more than 1 vaccine

is administered during a visit. ere can be only 1 rst administration

during a given visit. (See vignettes 3, 4, and 5 on pages 21–23.)

▶ If during a single encounter for a patient 18 years or younger, a physi-

cian or other QHP 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.

▶ e following vignettes may help illustrate the correct use of the

administration codes (see pages 25–28 for a full list of vaccine

product codes):

NOTE: e coding vignettes are for teaching purposes only and do not

necessarily follow every payer’s reporting requirements.

Vignette 1

A 2-month-old established patient presents for her checkup. e follow-

ing vaccines are ordered: Pentacel (diphtheria-tetanus-acellular pertussis

[DTaP], Haemophilus inuenzae type b [Hib], inactivated poliovirus

[IPV]), pneumococcal, and rotavirus. e physician counsels the parents

on all of them, consent is obtained and the nurse administers them all.

How are the appropriate codes for this service selected?

Step 1: Select appropriate E/M code.

99391

Preventive medicine service, established patient, infant

(age younger than 1 year)

Step 2: Select appropriate vaccine product codes.

90698

DTaP-Hib-IPV (Pentacel) product

90670 Pneumococcal product

90680 Rotavirus vaccine, oral use

Step 3: Select appropriate IA codes 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 QHP

perform the face-to-face vaccine counseling, discussing the specic

risks and benets of the vaccines?

If the answer to both questions is yes, select a code from the pediatric IA

code family (90460, 90461). If the answer to one of the questions is no,

select a code from the non–age-specic IA code family (90471–90474).

In this vignette, the answer to both questions is yes. erefore, IA codes

90460 and 90461 will be reported.

Step 4: Select the appropriate ICD-10-CM diagnosis codes.

Diagnosis codes are used along with CPT codes to reect the outcome

of a visit. e CPT codes tell a carrier what was done, and ICD-10-CM

codes tell a carrier why it was done.

e vaccine product CPT code and its corresponding IA CPT code are

always linked to the same ICD-10-CM code. is is because the vaccine

product and 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 receives a vaccine. e code is Z23, and it is reported at any

encounter when a vaccine is given, including routine well-child or

adult examinations.

e diagnosis codes for the 3 vaccines and 3 IA codes used in this vignette

are as follows:

CPT Codes ICD-10-CM Codes

99391 25 Preventive medicine service, established patient,

<1 year

Z00.129

90698 DTaP-Hib-IPV (Pentacel) product Z23

90670 Pneumococcal product Z23

90680 Rotavirus vaccine, oral use Z23

90460 (×3) Pediatric IA (Pentacel, pneumococcal, rotavirus),

ﬁrst component

Z23

90461 (×4) Pediatric IA (Pentacel), each additional

component

Z23

Vignette 2

A 5-year-old established patient is at a physician’s oce for her annual

well-child examination. e patient is scheduled to receive her rst

hepatitis A vaccine; her h DTaP vaccine; and the inuenza vaccine.

Aer distributing the Vaccine Information Statements and discussing

the risks and benets of immunizations with her parents, the physician

administers the vaccines.

How are the appropriate codes 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 codes.

90633 Hepatitis A vaccine, pediatric/adolescent dosage

(2-dose schedule), for intramuscular use

90700 DTaP, for use in individuals younger than 7 years,

for intramuscular use

90686 Inuenza virus vaccine, quadrivalent (IIV4), split virus,

preservative free, 0.5 mL dosage, for IM use

Step 3: Select appropriate IA codes 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

qualied health care professional perform the face-to-face vaccine

counseling, discussing the specic risks and benets of the vaccines?

If the answer to both questions is yes, select a code from the pediatric IA

code family (90460, 90461). If the answer to one of the questions is no,

select a code from the non–age-specic IA code family (90471–90474).

In this vignette, the answer to both questions is yes. erefore, IA codes

90460 and 90461 will be reported.

Step 4: Select the appropriate ICD-10-CM diagnosis codes.

Diagnosis codes are used along with CPT codes to reect the outcome

of a visit. e CPT codes tell a carrier what was done, and ICD-10-CM

codes tell a carrier why it was done.

e vaccine product CPT code and its corresponding IA CPT code are

always linked to the same ICD-10-CM code. is is because the vaccine

product and 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 receives a vaccine. e code is Z23, and it is reported at any

encounter when a vaccine is given, including routine well-child or

adult examinations.

e diagnosis codes for the 3 vaccines and 3 IA codes used in this

vignette are as follows:

CPT Codes ICD-10-CM Codes

99393 25 Preventive medicine service, established patient,

5–11 years

Z00.129

90633 Hepatitis A vaccine product Z23

90460 Pediatric IA (hepatitis A vaccine), ﬁrst component Z23

90700 DTaP vaccine product Z23

90460 Pediatric IA (DTaP vaccine), ﬁrst component Z23

90461 (×2) Pediatric IA (DTaP vaccine), each additional

component

Z23

90686 Inﬂuenza virus vaccine, quadrivalent, preservative

free, 0.5 mL dosage

Z23

90460 Pediatric IA (inﬂuenza vaccine), ﬁrst component Z23

Alternative Coding

CPT Codes ICD-10-CM Codes

99393 25 Preventive medicine service, established patient,

5–11 years

Z00.129

90633 Hepatitis A vaccine product Z23

90700 DTaP vaccine product Z23

90686 Inﬂuenza virus vaccine, quadrivalent, preservative

free, 0.5 mL dosage

Z23

90460 (×3) Pediatric IA (hepatitis A, DTaP, inﬂuenza vaccines),

ﬁrst component

Z23

90461 (×2) Pediatric IA (DTaP vaccine), second and third

components

Z23

NOTE: 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 coun-

seling, pediatric IA codes are reported (90460 and 90461). Each vaccine

administered will be reported with its own 90460 (hepatitis A, DTaP,

and inuenza). e only vaccine with multiple components is DTaP.

Because the rst component (ie, diphtheria) was counted in 90460, only

the second and third components (ie, tetanus and acellular pertussis) are

reported with 90461 with 2 units.

Vignette 3

A 19-year-old patient presents to the oce to complete a college physical

examination (in college the patient will be living in a dormitory). He is due

for a tetanus-diphtheria-acellular pertussis (Tdap) booster, meningococcal

vaccine, and intranasal inuenza vaccine. e physician counsels the

patient on each, and the nurse administers each.

CPT Codes ICD-10-CM Codes

99395 25 Preventive medicine service, established patient,

18–39 years

Z02.0

90715 Tdap product Z23

90471 IA, ﬁrst injection Z23

90734 Meningococcal conjugate vaccine (MenACWY-D

or MenACWY-CRM)

Z23

90472 IA, each additional injection Z23

90672 Inﬂuenza virus vaccine, quadrivalent, live (LAIV4),

for intranasal use

Z23

90474 IA, each additional oral or intranasal Z23

Rationale

e patient is older than 18 years; therefore, despite physician counseling,

pediatric IA codes cannot be reported. Instead, codes 90471 and 90474

must be used.

Vignette 4

A 17-year-old patient presents to the oce for her annual checkup and

to complete a college physical examination (in college the patient will be

living in a dormitory). e patient is healthy and due for a Tdap booster,

meningococcal vaccine, rst HPV (9-valent) vaccine, and inuenza

vaccine. e physician counsels the patient only on the meningococcal

and HPV vaccines, and the nurse administers each. e patient is asked

to return in 4 to 6 weeks for her second HPV vaccine.

CPT Codes

(First Visit Only)

ICD-10-CM Codes

(First Visit Only)

99395 25 Preventive medicine service, established patient,

12–17 years

Z00.0 and Z02.0

90734 Meningococcal (MCV4) product Z23

90651 HPV (9-valent) product Z23

90460 (×2) Pediatric IA (meningococcal and HPV), ﬁrst

component

Z23

90715 Tdap product Z23

90472 (×2) IA, each additional injection (Tdap) Z23

90686 Inﬂuenza virus vaccine, quadrivalent, preservative

free, 0.5 mL dosage

Z23

Rationale

Because the physician documents counseling only for the meningococcal

and HPV vaccines, code 90460 can be reported only for those vaccines

because the patient meets the age criteria. For the Tdap and inuenza

vaccines, defer to non-pediatric IA codes (90471, 90472). In this case,

however, a rst vaccine code is already reported with code 90460, so

the additional IA code 90472 has to be reported. While ICD-10-CM

does not provide ocial ages for the “adult” ICD-10-CM codes (Z00.00

and Z00.01) in lieu of the well-child examination codes, many payers

use age 17 years as the cuto. Refer to specic payer policy for details.

Vignette 5

A 6-month-old patient presents to the oce for her routine checkup and

to receive vaccines. e patient is due for DTaP, pneumococcal, and hepa-

titis B vaccines. During the examination, the physician nds an upper

respiratory infection and fever. e physician counsels the parent on the

vaccines but decides to defer for 2 weeks. e physician completes the

well-baby checkup on that day.

Two weeks later, the patient returns. e patient is afebrile and asymptom-

atic and is seen only by the nurse. e DTaP, pneumococcal, and hepatitis

B vaccines are administered.

CPT Code

(First Visit)

ICD-10-CM Code

(First Visit)

99391 Preventive medicine service, established

patient, <1 year

Z00.121

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)

90700 DTaP product Z23

90670 Pneumococcal product Z23

90744 Hepatitis B vaccine product Z23

90471 IA (DTaP), ﬁrst vaccine Z23

90472 (×2) IA (pneumococcal, hepatitis B), each

additional vaccine

Z23

Rati

onale

If counseling occurs outside the IA service, there is no way to report it

separately. erefore, in this vignette, there is nothing separate to report

during the well-baby visit, and when the patient returns and sees only the

nurse, 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 signicant and

separately identiable. Code 9921x is reported with modier 25. When

the patient returns only for vaccines, an E/M service is not reported. e

ICD-10-CM code will be reported for with abnormal ndings (Z00.121)

because an abnormality was identified during the encounter.

For more information on IA codes, refer to the AAP's coding website

(www.aap.org/coding) and its page dedicated to vaccine coding.

How to Code When Immunizations Are Not Administered

ICD-CM-10 Codes

▶ For many reasons, immunizations are not given during routine pre-

ventive 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.

▶ Because of tracking purposes and quality measures, it is important

to report non-administration as part of the ICD-10-CM codes. e

following ICD-10-CM codes were created to report why a vaccine is

not given:

Vaccination not carried out due to

Z28.01

Acute illness

Z28.02 Chronic illness or condition

Z28.03 Immunocompromised state

Z28.04 Allergy to vaccine or component

Z28.1 Religious reasons

Z28.20 Unspecied reason

Z28.21 Patient refusal

Z28.81 Patient had disease being vaccinated against

Z28.82 Caregiver refusal

Z28.83 Vaccine was unavailable (eg, manufacturer delay)

Z28.89 Other reason

Vignette

A 1-year-old presents for his routine well-child examination. He is

scheduled to receive his rst measles, mumps, rubella; hepatitis A; and

varicella vaccines. Because he had a documented case of varicella when

he was 9 months of age, 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 having had the

disease being vaccinated against

COVID-19 IA

As the public health emergency continues to evolve so does coding

for the COVID-19 vaccines. Refer to the online resource for more

information on reporting COVID-19 vaccines (https://www.aap.org/en/

pages/2019-novel-coronavirus-covid-19-infections/covid-19-vaccine-for-

children/covid-19-vaccine-administration-getting-paid/)

Tips:

▶ Do not charge for the product; however, you may report it if the payer

wants the product code included.

▶ Each specic vaccine and dose has its own unique administration code.

▶ If giving a COVID-19 vaccine in addition to routine vaccines,

a modier might be required to override any payer edits.

VACCINES FOR CHILDREN PROGRAM

e rules for reporting vaccines for patients who qualify for the Vaccines

for Children (VFC) program vary greatly. Some states require that the

product code be submitted, while others require the IA codes. Some

require the use of modiers, while others do not. Currently, the VFC

program does not recognize component-based vaccine counseling; there-

fore, you will not be paid for CPT

code 90461. e American Academy

of Pediatrics continues to work on changing this so pediatric providers

can be properly compensated for giving multiple-component vaccines.

Also be sure to check with your individual state Medicaid plan for vary-

ing rules, including, but not limted to, being able to report code 99211

in addition to IA codes for vaccine-only encounters. Be sure to get

these rules in writing.

Commonly Administered Pediatric Vaccines (Excludes COVID-19 vaccines -

refer to link on page 24)

Product

Code

Separately report the

administration with

codes 90460–90461

or 90471–90474. Manufacturer Brand

No. of

Vaccine

Components

90702 Diphtheria and tetanus

toxoids (DT), adsorbed when

administered to younger than

seven years, for IM use

SP Diphtheria

and Tetanus

Toxoids

Adsorbed

90700 Diphtheria, tetanus toxoids,

and acellular pertussis vaccine

(DTaP), when administered to

<7 years, for IM use

GSK

DAPTACEL

INFANRIX

90696 Diphtheria, tetanus toxoids,

and acellular pertussis vaccine

and inactivated poliovirus

vaccine (DTaP-IPV), when

administered to children

4-6 years of age, for IM use

GSK

KINRIX

Quadracel

90697 Diphtheria, tetanus toxoids,

acellular pertussis vaccine,

inactivated poliovirus vaccine,

w PRP-OMP conjugate

vaccine, and hepatitis B

vaccine (DTaP-IPV-Hib-HepB),

for IM use

Merck/SP VAXELIS 6

Commonly Administered Pediatric Vaccines (continued)

Product

Code

Separately report the

administration with

codes 90460–90461

or 90471–90474. Manufacturer Brand

No. of

Vaccine

Components

90698 Diphtheria, tetanus toxoids,

acellular pertussis vaccine,

Haemophilus inﬂuenzae type b,

and inactivated poliovirus

vaccine (DTaP-IPV/Hib),

for IM use

SP Pentacel 5

90723 Diphtheria, tetanus toxoids,

acellular pertussis vaccine,

Hepatitis B, and inactivated

poliovirus vaccine (DTaP-

Hep B- IPV), for IM use

GSK PEDIARIX 5

90633 Hepatitis A vaccine (Hep A),

pediatric/adolescent dosage,

2 dose, for IM use

GSK

Merck

HAVRIX

VAQTA

90740 Hepatitis B vaccine (Hep B),

dialysis or immunosuppressed

patient dosage, 3 dose,

for IM use

Merck RECOMBIVAX

90743 Hepatitis B vaccine (Hep B),

adolescent, 2 dose, for IM use

Merck RECOMBIVAX

90744 Hepatitis B vaccine (Hep B),

pediatric/adolescent dosage,

3 dose, for IM use

Merck

GSK

RECOMBIVAX

ENERGIX-B

90746 Hepatitis B vaccine (Hep B),

adult dosage, for IM use

Merck

GSK

RECOMBIVAX

ENERGIX-B

90747 Hepatitis B vaccine (Hep B),

dialysis or immunosuppressed

patient dosage, 4 dose,

for IM use

GSK ENERGIX-B 1

90647 Haemophilus inﬂuenzae type b

vaccine (Hib), PRP-OMP

conjugate, 3 dose, for IM use

Merck PedvaxHIB 1

90648 Haemophilus inﬂuenzae type b

vaccine (Hib), PRP-T conjugate,

4 dose, for IM use

GSK

ActHIB

HIBERIX

90651 Human Papillomavirus vaccine

types 6, 11, 16, 18, 31, 33, 45,

52, 58, nonavalent (HPV), 2 or

3 dose schedule, for IM use

Merck GARDASIL 9 1

Product

Code

Separately report the

administration with

codes 90460–90461

or 90471–90474. Manufacturer Brand

No. of

Vaccine

Components

90707 Measles, mumps, and rubella

virus vaccine (MMR), live, for

subcutaneous use

Merck M-M-R II 3

90710 Measles, mumps, rubella, and

varicella vaccine (MMRV), live,

for subcutaneous use

Merck ProQuad 4

90619 Meningococcal conjugate

vaccine, serogroups A, C, W, Y,

quadrivalent, tetanus toxoid

carrier (MenACWY-TT), for

IM use

SP MenQuadﬁ 1

90620 Meningococcal recombinant

protein and outer membrane

vesicle vaccine, serogroup B

(MenB-4C), 2 dose schedule,

for IM use

GSK Bexsero 1

90621 Meningococcal recombinant

lipoprotein vaccine, serogroup B,

2 or 3 dose schedule, for IM use

Pﬁzer Trumenba 1

90734 Meningococcal conjugate

vaccine, serogroups A, C, W, Y,

quadrivalent, diphtheria toxoid

carrier (MenACWY-D) or CRM197

carrier(MenACWY-CRM), for

IM use

GSK

Menactra

Menveo

90670 Pneumococcal conjugate

vaccine, 13 valent (PCV13),

for IM use

Pﬁzer PREVNAR 13 1

90732

Pneumococcal polysaccharide

vaccine, 23-valent (PPSV23),

adult or immunosuppressed

patient dosage, when adminis-

tered to 2 years or older, for

subcutaneous or IM use

Merck PNEUMOVAX

90713 Poliovirus vaccine (IPV),

inactivated, for subcutaneous

or IM use

SP IPOL 1

90680 Rotavirus vaccine, pentavalent

(RV5), 3 dose schedule, live,

for oral use

Merck RotaTeq 1

90681 Rotavirus vaccine, human,

attenuated (RV1), 2 dose

schedule, live, for oral use

GSK ROTARIX 1

Commonly Administered Pediatric Vaccines (continued)

Product

Code

Separately report the

administration with

codes 90460–90461

or 90471–90474.

Manufacturer Brand

No. of

Vaccine

Components

90714 Tetanus and diphtheria toxoids

(Td) adsorbed, preservative

free, when administered to

seven years or older, for IM use

MBL

TDVAX

TENIVAC

90715 Tetanus, diphtheria toxoids

and acellular pertussis vaccine

(Tdap), when administered to

7 years or older, for IM use

GSK

ADACEL

BOOSTRIX

90716 Varicella virus vaccine (VAR),

live, for subcutaneous use

Merck VARIVAX 1

90749 Unlisted vaccine or toxoid Please see CPT manual.

90672 Inﬂuenza virus vaccine, quad

(LAIV), live, intranasal use

AstraZeneca Flumist Quad 1

90674 Inﬂuenza virus vaccine, quad

(ccIIV4), derived from cell

cultures, subunit, preservative

and antibiotic free, 0.5 mL

dosage, IM

Seqirus Flucelvax 1

90682 Inﬂuenza virus vaccine,

quad (RIV4), derived from

recombinant DNA, HA protein

only, preservative and

antibiotic free, IM use

Seqirus Flublok Quad 1

90685 Inﬂuenza virus vaccine, quad

(IIV4), split virus, preservative

free, 0.25ml dose, for IM use

Seqirus

GSK

Aﬂuria

Fluarix

Fluzone Quad

90686 Inﬂuenza virus vaccine, quad

(IIV4), split virus, preservative

free, 0.5ml dosage, for IM use

Seqirus

GSK

Aﬂuria

FLUARIX Quad

FLULAVAL

Fluzone Quad

90687 Inﬂuenza virus vaccine,

quad (IIV4), split virus,

0.25ml dosage, for IM use

Seqirus

Aﬂuria Quad

Fluzone Quad

90688 Inﬂuenza virus vaccine,

quad (IIV4), split virus,

0.5ml dosage, for IM use

Seqirus

Aﬂuria

Fluzone Quad

90756 Inﬂuenza virus vaccine, quad

(ccIIV4), derived from cell

cultures, subunit, antibiotic

free, 0.5mL dosage, for IM use

Seqirus Flucelvax Quad 1

Current at time of publication. Developed and maintained by the American Academy of Pediatrics. Updated

periodically at https://downloads.aap.org/AAP/PDF/coding_vaccine_coding_table.pdf. For reporting purposes

only. Any vaccine products still US Food and Drug Administration pending are not listed in this resource.

LABORATORY

Two dierent practice models surround the conducting of laboratory

tests: blood is drawn in oce 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 nancially responsible for

and billed by the outside laboratory. In those cases, report only 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.

CPT Code

99000 Handling and/or conveyance of specimen for transfer from

the physician’s oce to a laboratory

Venipuncture CPT Codes

36406 Venipuncture, younger than 3 years, necessitating physician’s

skill, not to be used for routine venipuncture

36410 Venipuncture, 3 years or older, necessitating physician’s skill,

for diagnostic or therapeutic purposes (not to be used for

routine venipuncture)

36415 Collection of venous blood by venipuncture

36416 Collection of capillary blood specimen (eg, nger, heel, ear stick)

Venipuncture ICD-10-CM Codes

Link to ICD-10-CM codes for the well-child examination or for specic

screening tests.

Model 2: Blood is drawn and laboratory tests are performed in the

physician’s practice.

Venipuncture CPT Codes

36406 Venipuncture, younger than 3 years, necessitating physician’s

skill, not to be used for routine venipuncture

36410 Venipuncture, 3 years or older, necessitating physician’s skill,

for diagnostic or therapeutic purposes (not to be used for

routine venipuncture)

36415 Collection of venous blood by venipuncture

36416 Collection of capillary blood specimen (eg, nger, heel, ear stick)

Venipuncture ICD-10-CM Codes

Link to ICD-10-CM codes for the well-child examination or for specic

screening tests.

Anemia Screening CPT Code

85018 Blood count; hemoglobin

Anemia Screening ICD-10-CM Code

Z13.0 Encounter for screening for diseases of the blood and

blood-forming organs and certain disorders involving the

immune mechanism (eg, anemia)

Bilirubin CPT Codes

82247 Bilirubin, total

88720 Bilirubin, total, transcutaneous

Bilirubin ICD-10-CM Code

Z13.228 Encounter for screening for other metabolic disorder

Dyslipidemia Screening CPT Codes

80061 Lipid panel (includes total cholesterol, high-density lipoprotein

[HDL] cholesterol, and triglycerides)

82465 Cholesterol, serum, total

83718 Lipoprotein, direct measurement, high-density cholesterol

(HDL cholesterol)

84478 Triglycerides

Dyslipidemia Screening ICD-10-CM Code

Z13.220 Encounter for screening for lipid disorders

Hepatitis B Screening CPT Codes

86704 Hepatitis B core antibody (HBcAb); total

86705 IgM antibody

86706 Hepatitis B surface antibody (HBsAb)

86707 Hepatitis Be antibody (HBeAb)

87340 Infectious agent antigen detection by immunoassay technique

qualitative or semiquantitative hepatitis B surface antigen

(HBsAg)

Hepatitis B Screening ICD-10-CM Code

Z20.5 Contact with and (suspected) exposure to viral hepatitis

Z11.59 Encounter for screening for other viral diseases

Hepatitis C Screening CPT codes

86803 Hepatitis C antibody;

86804 Hepatitis C antibody; conrmatory test (eg, immunoblot)

87520 Infectious agent detection by nucleic acid (DNA or RNA);

hepatitis C, direct probe technique

87521 Infectious agent detection by nucleic acid (DNA or RNA);

hepatitis C, amplied probe technique, includes reverse

transcription when performed

Hepatitis C Screening ICD-10-CM Code

Z20.5 Contact with and (suspected) exposure to viral hepatitis

Z11.59 Encounter for screening for other viral diseases

Lead Screening CPT Code

83655 Lead

Lead Screening ICD-10-CM Code

Z13.88 Encounter for screening for disorder due to exposure to

contaminants

Newborn Metabolic Screening HCPCS Code

NOTE: See Healthcare Common Procedure Coding System Codes section

on page 34 for explanation of HCPCS codes.

S3620 Newborn metabolic screening panel, includes test kit, postage,

and the laboratory tests specied by the state for inclusion

in this panel (eg, galactose; hemoglobin, electrophoresis;

hydroxyprogesterone, 17-D; phenylalanine [phenylketonuria

(PKU)]; and thyroxine, total)

NOTE: Only report code S3620 if you are billing for the actual running of

the laboratory test or test kit. Otherwise only report the appropriate blood

collection code (eg, 36416).

Newborn Metabolic Screening ICD-10-CM Codes

Report the diagnosis codes for the state-specic newborn screening tests

conducted. Examples include

Z13.0

Encounter for screening for diseases of the blood and

blood-forming organs and certain disorders involving the

immune mechanism (eg, anemia, sickle cell)

Z13.21 Encounter for screening for nutritional disorder

Z13.228 Encounter for screening for other metabolic disorders

(eg, PKU, galactosemia)

Z13.29 Encounter for screening for other suspected endocrine

disorder (eg, thyroid)

Papanicolaou Smear HCPCS Code

NOTE: See Healthcare Common Procedure Coding System Codes section

on page 34 for explanation of HCPCS codes.

Q0091 Screening Papanicolaou smear; obtaining, preparing, and

conveyance of cervical or vaginal smear to laboratory

Papanicolaou Smear CPT Code

Collection of a cervical specimen via a pelvic examination is included in

the preventive medicine service code (99381–99385 and 99391–99395).

Papanicolaou Smear ICD-10-CM Codes

Z12.4 Encounter for screening for malignant neoplasm of cervix

(excludes HPV)

Z12.72 Encounter for screening for malignant neoplasm of vagina

Z12.79 Encounter for screening for malignant neoplasm of other

genitourinary organs

Z12.89 Encounter for screening for malignant neoplasms of other sites

Tuberculosis Testing (Mantoux/Puriﬁed Protein Derivative [PPD])

Administration of PPD Test

CPT Code ICD-10-CM Code

86580

Skin test; tuberculosis,

intradermal

Z11.1

Encounter for screening for

respiratory tuberculosis

NOTE: ere is no separate administration code for the PPD test.

Do not report one.

Reading of PPD Test

If patient returns to have a nurse read the test results, report

CPT Codes ICD-10-CM Codes

99211 Ofﬁce or other outpatient

services (negative PPD

outcome)

Z11.1 Encounter for screening

for respiratory tuberculosis

(if test is negative)

99212– Ofﬁce or outpatient services

99215 (physician service for positive

encounter)

R76.11 Nonspeciﬁc reaction to

tuberculin skin tuberculosis

(if test is positive)

Sexually Transmitted Infection and HIV Screening CPT Codes

86701 Antibody; HIV-1

86703 Antibody; HIV-1 and HIV-2; single assay

87490 Infectious agent detection by nucleic acid (DNA or RNA);

Chlamydia trachomatis, direct probe technique

87491

Infectious agent detection by nucleic acid (DNA or RNA);

C trachomatis, amplied probe technique

87590

Infectious agent detection by nucleic acid (DNA or RNA);

Neisseria gonorrhoeae, direct probe technique

87591

Infectious agent detection by nucleic acid (DNA or RNA);

N gonorrhoeae, amplied probe technique

87810

Infectious agent detection by immunoassay with direct

optical observation; C trachomatis

87850

Infectious agent detection by immunoassay with direct

optical observation; N gonorrhoeae

Sexually Transmitted Infection and HIV Screening ICD-10-CM Codes

Z11.3 Encounter for screening for infections with a predominantly

sexual mode of transmission (excludes HPV and HIV)

Z11.8 Encounter for screening for other infectious and parasitic

diseases (eg, chlamydia)

HEALTHCARE COMMON PROCEDURE CODING SYSTEM CODES

▶ e 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.

▶ e 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

S0302

Completed Early and Periodic Screening, Diagnosis, and

Treatment service (List in addition to code for appropriate

E/M service.)

S0610 Annual gynecologic examination; new patient

S0612 Annual gynecologic examination; established patient

S0613 Annual gynecologic examination, clinical breast examination

without pelvic examination

S0622 Routine examination for college, new or established patient

(List separately in addition to appropriate E/M code.)

S9444 Parenting classes, nonphysician provider, per session

S9445 Patient education, not otherwise classied, nonphysician

provider, individual, per session

S9446 Patient education, not otherwise classied, nonphysician

provider, group, per session

S9447 Infant safety (including cardiopulmonary resuscitation)

classes, nonphysician provider, per session

S9451 Exercise classes, nonphysician provider, per session

S9452 Nutrition classes, nonphysician provider, per session

S9454 Stress management classes, nonphysician provider, per session

Commonly Reported ICD-10-CM Codes for Pediatric Preventive Services

ICD-10-CM

Code Descriptor

Special Coding

Conventions

Encounter and Examination Codes

Z00.110 Newborn check under 8 days old Outpatient codes only

Z00.111 Newborn check 8 to 28 days old Outpatient codes only

Z00.121

Z00.129

Routine child health examination

with abnormal ﬁndings

without abnormal ﬁndings

First-listed ICD-10-CM

code only.

Z00.00

Z00.01

General adult medical examination

without abnormal ﬁndings

with abnormal ﬁndings

First-listed ICD-10-CM

code only.

Typically used for patients

18 years and older

(payer policy).

Z02.0 Examination for admission to

educational institution

Not required in addition

to a Z00 code

Z02.4 Examination for driving license

Z02.5 Examination for participation in sport

Z01.110 Hearing 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.

Z23 Immunizations This is the only code in

ICD-10-CM for vaccines.

Link to both the product

and administration

CPT codes.

Z29.3 Encounter for prophylactic ﬂuoride

administration

Commonly Reported ICD-10-CM Codes for Pediatric Preventive Services (continued)

ICD-10-CM

Code Descriptor

Special Coding

Conventions

Screening Codes

A screening code is not necessary if the screening is inherent to a routine examination,

but it can be reported and oftentimes payers require it.

Z11.1 Respiratory tuberculosis

Z11.3 Infections with a predominantly sexual mode of

transmission (excludes HPV and HIV)

Z12.4 Malignant neoplasm of cervix (excludes HPV)

Z11.51 Human papillomavirus (HPV)

Z11.59 Other viral diseases (eg, Hep B)

Z12.79 Malignant neoplasm of other genitourinary organs

Z12.89 Malignant neoplasms of other sites

Z13.0 Diseases of the blood and blood-forming organs

and certain disorders involving the immune

mechanism (eg, anemia, sickle cell)

Z13.1 Diabetes mellitus

Z13.21 Nutritional disorder

Z13.220 Lipid disorders

Z13.228 Other metabolic disorders (eg, inborn errors of

metabolism, galactosemia, PKU)

Z13.29 Other endocrine disorder

Z13.31 Depression screening

Z13.39 Encounter for screening examination for other

mental health and behavioral disorders

(eg, alcoholism, suicide ideation)

Z13.41 Autism screening

Z13.42 Global developmental delays (milestones)

screening

Z13.88 Disorder due to exposure to contaminants

(eg, lead)

Z13.89 Other speciﬁed disorders (not listed here)

ICD-10-CM

Code Descriptor

Special Coding

Conventions

Preventive Counseling

Z71.3 Dietary surveillance and counseling

Z71.82 Exercise counseling

Z71.84 Health counseling related to travel

Z71.89 Other speciﬁed counseling

Z71.9 Counseling, unspeciﬁed

Underimmunized Status

Z28.3 Underimmunized status A status code is

informative and may

affect the course

of treatment and

its outcome. Report

when this is the case.

Vaccines Not Given

Z28.01 Acute 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 Patient had disease being vaccinated for

Z28.1 Religious reasons

Z28.89 Other reason

Z28.83 Vaccine was unavailable (eg, manufacturer delay)

Z28.20 Unspeciﬁed reason

Social Determinants of

Health

When identiﬁed during a routine preventive medicine service encounter, either through

a formal screening instrument or surveillance, they should be addressed as appropriate

and coded for. Listed below are a few of the SDOH codes in the ICD-10-CM code set;

however, always refer to the larger code set for others. For more information on coding

for SDOH issues and services visit https://downloads.aap.org/AAP/PDF/SDOH.pdf.

Social Determinants Of Health

Abuse

T74.02- Child neglect or abandonment

T74.12- Child physical abuse

T74.22- Child sexual abuse

T74.32- Child psychological abuse

T74.52- Child sexual exploitation

T74.62- Child forced labor exploitation

Z62.81- Personal history of abuse in childhood

Z69- Encounter for mental health services for victim of abuse

Economic

Z59.5 Extreme poverty

Z59.6 Low income

Z59.7 Insufﬁcient social insurance and welfare support

Family Issues

Z63.31 Absence of family member due to military deployment

Z63.32 Other absence of family member

Z63.4 Disappearance and death of family member

Z63.5 Disruption of family by separation and divorce

Z63.72 Alcoholism and drug addiction in family

Z63.79 Other stressful life events affecting family and household

Z62.82- Parent-child conﬂict

Z62.890 Parent-child estrangement NEC

Food & Water Issues

Z59.41 Food insecurity

Z58.6 Unsafe drinking-water supply

Living situation

Z62.21 Child in welfare custody

Z59.0- Homelessness

Z59.81 Housing instability

Social Determinants Of Health

Z62.22 Institutional upbringing

Z62.29 Other upbringing away from parents

Social Issues

Z60.3 Acculturation difﬁculty

Z60.4 Social exclusion and rejection

Z60.5 Target of (perceived) adverse discrimination and persecution

- Indicates another character is required to complete the code.

Healthcare Effectiveness Data and Information Set Measures Related to

Pediatric Preventive Care

Measure Topic Measure Coding Options

Child and Adolescent

Well-Care Visits:

Well-Child Visits in

the First 15 Months

of Life (W15)

At least 6 well-child examinations

by 15 months of age

ICD-10-CM

Z00.110, Z00.111,

Z00.121, Z00.129

CPT

99381, 99382,

99391, 99392

Child and Adolescent

Well-Care Visits:

Well-Child Visits in

the Third, Fourth,

Fifth, and Sixth Years

of Life (W34)

One or more comprehensive

well-child visits with a PCP

(per year)

ICD-10-CM

Z00.121, Z00.129

CPT

99382, 99392

Child and Adolescent

Well-Care Visits:

Adolescent Well-Care

Visits (AWC)

At least one annual

comprehensive well-care

encounter (per year) for

adolescents and young

adults aged 12–21 years

ICD-10-CM

Z00.00, Z00.01,

Z00.121, Z00.129

CPT

99384, 99385,

99394, 99395

Lead Screening in

Children (LSC)

By age 2 years, have had one or

more capillary or venous lead

blood tests for lead poisoning

CPT

83655

Chlamydia Screening

in Women (CHL)

Sexually active women aged

16–24 years who received at

least one chlamydia test

each year

CPT

87110, 87270,

87320, 87490–87492,

87810

Healthcare Effectiveness Data and Information Set Measures Related to

Pediatric Preventive Care (continued)

Measure Topic Measure Coding Options

Childhood

Immunization

Status (CIS) and

Immunizations for

Adolescents (IMA)

By age 2 y, have

DTaP (4 doses)

IPV (3 doses)

MMR (1 dose)

Hib (3 doses)

Hep B (3 doses)

Varicella (1 dose)

Pneumococcal (4 doses)

Hep A (1 dose)

Rotavirus (2–3 doses)

Inﬂuenza (2 doses)

By 13th birthday, have

Meningococcal (1 dose)

(Ages 11–13 y)

Tdap (1 dose)

(Ages 10–13 y)

HPV (males/females) (2–3 doses)

(Ages 9–13 y)

Varies; refer to the

Commonly Administered

Pediatric Vaccines table

on pages 25–28 for

speciﬁc vaccine codes.

Weight Assessment

and Counseling for

Nutrition and Physical

Activity for Children/

Adolescents (WCC)

For those aged 3–17 years who

had an outpatient visit with a PCP

during the measurement year and

had evidence of BMI percentile

documentation and counseling for

nutrition and/or physical activity

ICD-10-CM

Z68.51–Z68.54,

Z71.3, Z02.5, Z71.82

CPT

3000F

Abbreviations: BMI, body mass index; CPT, Current Procedural Terminology; DTaP, diphtheria, tetanus,

acellular pertussis; Hep A, hepatitis A; Hep B, hepatitis B; Hib, Haemophilus inﬂuenzae type b; HPV, human

papillomavirus; ICD-10-CM, International Classiﬁcation of Diseases, 10th Revision, Clinical Modiﬁcation;

IPV, inactivated poliovirus; MMR, measles, mumps, rubella; PCP, primary care practitioner; Tdap, tetanus,

diphtheria, acellular pertussis.

Body mass index codes should only be reported when there is a related condition (eg, obesity). Payers need to

accept 3000F in lieu of BMI ICD-10-CM codes for the BMI measure unless the patient has a related condition.

This program is supported by the Health Resources and

Services Administration (HRSA) of the U.S. Department of

Health and Human Services (HHS) as part of an award totaling

$5,000,000 with 10 percent nanced with non-governmental

sources. The contents are those of the author(s) and do not

necessarily represent the ocial views of, nor an endorsement,

by HRSA, HHS, or the U.S. Government. For more information,

please visit HRSA.gov.

BFNC.2022.CPPCFEB

3-362/0222

Also From Bright Futures!

Bright Futures Tool and Resource Kit, 2nd Edition

is online resource provides health care professionals with an organized and

integrated compilation of current forms and materials needed to perform a

well-child visit on one website. e new online platform allows easy access to

the core tools for health supervision visits, including previsit questionnaires,

visit documentation forms, parent and patient education handouts, and

additional documentation forms and AAP-developed educational resources.

Bright Futures: Guidelines for Health Supervision of Infants, Children,

and Adolescents, 4th Edition

is essential resource provides key background information and recommenda-

tions for themes critical to healthy child development along with well-child

supervision standards for 31 age-based visits—from newborn through 21 years.

Additional Pediatric Coding Resources From

the American Academy of Pediatrics

NEW EDITION!

Coding for Pediatrics 2022: A Manual for Pediatric Documentation and

Payment, 27th Edition

Code it right the first time—and avoid delays and costly denials—with this widely

used pediatric coding resource. This year’s updated 27th edition includes all

changes in CPT and ICD-10-CM codes—complete with expert guidance for their

application.

NEW EDITION!

Pediatric ICD-10-CM 2022: A Manual for Provider-Based Coding, 7th Edition

is convenient resource condenses the vast ICD-10-CM code set into 500+ pages

of pediatric-related codes and guidelines.

NEW EDITION!

AAP Pediatric Coding Newsletter™

is print and online monthly publication brings you proven coding strategies and

how-to help with your toughest coding and payment challenges!

To order these and other pediatric resources,

visit shop.aap.org.