With over half a million cases currently reported in the US every day, the COVID-19 pandemic is far from being over. A constant feeling of responsibility mixed with a trivial fear of getting sick from yet another new variant of the virus has encouraged millions of Americans to get a jab.
As safe as they are, unfortunately, COVID-19 vaccines may sometimes trigger side effects. In most cases, a sore arm and a mild headache are what can make you feel slightly “under the weather” after getting a dose. However, some people experience serious complications after getting a COVID-19 vaccine, and they may be seeking qualified help.
Now, there is a question – which diagnosis codes should be used to indicate a post-vaccination condition?
Healthcare practitioners may report vaccine side effects using applicable ICD-10 codes for each condition. For example, if a patient is experiencing a sore arm, M79.603 can be put on a claim. This code is used to describe an unspecified pain in the arm. However, there is also a diagnosis code that must be used in order to demonstrate the fact that a patient is experiencing side effects after vaccination. Namely, T50.B95A is used to report an adverse effect of other viral vaccines (initial encounter). At the same time, there are several ICD-10 codes that can be used to describe a post-vaccination condition in a greater level of detail, such as the following:
• T80.52XD - anaphylactic reaction due to vaccination
• T80.62XD - other serum reaction due to vaccination
These codes are billable and reimbursable by Medicare/Medicaid and commercial insurance payers.
WCH Service Bureau would like to remind you that improper or fraudulent coding leads to underpayments and penalties applied on a healthcare provider. The billed diagnoses and procedure codes must always indicate a genuine clinical condition and demonstrate a strong medical necessity for performed services. No discrepancies are tolerated.
