2025 ICD-10-CM code Z71.85
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Factors influencing health status and contact with health services - Persons encountering health services in other circumstances Factors influencing health status and contact with health services (Z00-Z99) Feed
Encounter for immunization safety counseling;used when counseling extends beyond routine immunization.
Modifier 25 (significant, separately identifiable E/M service) may be appended to an E/M code if the counseling is considered a significant portion of the visit separate from the administration of vaccines.
Medical necessity is established when a patient exhibits significant vaccine hesitancy or requires extensive counseling regarding vaccine safety due to specific medical conditions, concerns, or misinformation.The documentation must clearly demonstrate the need for extended counseling beyond typical routine vaccination practices.
The clinical responsibility involves counseling patients and/or caregivers about vaccine safety concerns, answering questions, and addressing hesitancy. This may include discussing risks and benefits of specific vaccines, alternative schedules, and addressing misinformation. The physician must appropriately document the time spent, the specific concerns addressed, and the patient's response to counseling.
- Factors influencing health status and contact with health services (Z00-Z99)
- Z71.85 falls under the broader category of "Factors influencing health status and contact with health services" and the subcategory "Persons encountering health services in other circumstances."
In simple words: This code is used when a doctor or other healthcare provider spends extra time talking to a patient or their family about the safety of a vaccine. This happens when the patient has concerns or wants to discuss vaccine safety in more detail than usual.If the patient gets a vaccine that day, the doctor will also use another code to show that the vaccine was given.
This ICD-10-CM code signifies an encounter where the primary reason is counseling regarding the safety of vaccines.It's used when the time spent counseling exceeds what's typical for routine immunizations, often addressing vaccine hesitancy or requests for alternative immunization schedules.This code should not be used for general information on vaccine risks and side effects provided during routine vaccination encounters.If a vaccine is administered during the same encounter, code Z23 (encounter for immunization) should also be reported. The sequencing of these codes depends on the circumstances of the visit.
Example 1: A patient expresses concern about the safety of the COVID-19 vaccine due to misinformation encountered online. The physician spends 20 minutes discussing the vaccine's development, efficacy, and safety profile, addressing the patient's specific anxieties. The patient decides to proceed with vaccination, which is administered the same day. Both Z71.85 and Z23 are reported, along with appropriate E/M and vaccination codes., A parent is hesitant to vaccinate their child according to the recommended schedule, opting for a delayed approach. The pediatrician spends 30 minutes explaining the potential risks of delaying vaccination and emphasizing the importance of timely immunization. The patient agrees to proceed with a partial vaccination schedule.Z71.85 is reported as the principal diagnosis, along with codes for the administered vaccines., A patient, recently diagnosed with an autoimmune disorder, is concerned about the safety of receiving certain vaccines due to potential interactions with their medication. The physician spends 15 minutes addressing these concerns, reviewing the patient's medical history and discussing appropriate vaccination strategies.Z71.85 is reported, along with codes for other issues addressed and any vaccinations given.
Detailed documentation is crucial.This should include: the specific vaccines discussed; the patient's or caregiver's concerns and questions; the provider's responses and explanations; time spent counseling; the patient's decision regarding vaccination; and any subsequent actions, such as vaccination administration or referral to other specialists.All documented information should support medical necessity.
** Accurate coding requires detailed and thorough documentation of the encounter to support medical necessity and justify the use of Z71.85. The time spent counseling should be clearly documented and justified in the medical record. This code is not intended for routine vaccine safety information provided during standard vaccination visits.
- Payment Status: Active
- Specialties:Family Medicine, Pediatrics, Internal Medicine, Infectious Disease
- Place of Service:Office, Outpatient Hospital, Clinic