What is the ICD-10 (International Classification of Diseases, 10th Revision) code for pneumonia vaccine administration?

ICD-10 Codes for Pneumococcal Vaccination

The ICD-10 code for pneumococcal vaccine administration is Z23, which covers "Encounter for immunization." For more specific documentation of pneumococcal vaccination status or history, use Z87.891 for "Personal history of nicotine dependence" if relevant to vaccination indication, or use codes from the Z28 series if documenting reasons for non-administration.

Primary Code for Vaccine Administration

• Z23 is the appropriate ICD-10 code when the encounter is specifically for administering the pneumococcal vaccine 1
• This code applies regardless of which pneumococcal vaccine formulation is used (PCV13, PCV15, PCV20, or PPSV23) 2, 3

Additional Codes to Document Vaccination Indications

When documenting why a patient qualifies for pneumococcal vaccination, include the underlying condition codes:

• I50.x series for chronic heart failure or cardiomyopathy 1
• J44.x for chronic obstructive pulmonary disease (COPD) or emphysema 1
• E11.x for diabetes mellitus 1, 4
• K70.x for alcoholic liver disease or K74.x for cirrhosis 1
• F17.2xx for nicotine dependence (smoking), which is an explicit indication for vaccination in adults under 65 2
• D57.x for sickle cell disease 1
• B20 for HIV infection 1
• Z94.x for solid organ transplant status 2

Age-Based Coding Considerations

• For adults ≥65 years receiving routine pneumococcal vaccination, Z23 alone is sufficient as age itself is the indication 1
• For adults 19-64 years, include both Z23 and the specific chronic condition code(s) that qualify them for vaccination 2, 4
• For children <2 years receiving routine PCV vaccination, Z23 is the primary code 1

Common Clinical Scenarios

Scenario 1: 70-year-old receiving PCV20

• Primary code: Z23 3
• No additional codes needed unless documenting specific risk factors 3

Scenario 2: 56-year-old with diabetes receiving PCV20

• Primary code: Z23 4
• Secondary code: E11.x (specific diabetes code) 4

Scenario 3: 45-year-old smoker with COPD receiving pneumococcal vaccine

• Primary code: Z23 2
• Secondary codes: J44.x (COPD) and F17.2xx (nicotine dependence) 2

Important Documentation Pitfalls

• Do not use pneumonia diagnosis codes (J12-J18) when the encounter is solely for vaccination 5
• Avoid using Z28.x codes (immunization not carried out) when the vaccine is actually administered 1
• When billing for vaccine administration during a hospitalization for pneumonia, the pneumonia code (J12-J18) should be primary, with Z23 as secondary 1
• For patients receiving vaccination at hospital discharge after pneumonia, code both the pneumonia diagnosis and Z23, with the pneumonia as the principal diagnosis if it was the reason for admission 1

Vaccine Product-Specific Considerations

While Z23 covers all pneumococcal vaccine encounters, documentation should specify which vaccine was given:

• PCV20 (20-valent pneumococcal conjugate vaccine) 2, 3
• PCV15 (15-valent pneumococcal conjugate vaccine) 2, 4
• PPSV23 (23-valent pneumococcal polysaccharide vaccine) 1
• PCV13 (13-valent pneumococcal conjugate vaccine, if still being used) 1

This specificity aids in tracking vaccination history for future dose timing, as intervals between different pneumococcal vaccines vary (≥1 year between most doses, ≥5 years in certain scenarios) 2.