The RCxRules Blog

Keeping Pace: Complex Immunization Requirements

vaccination billing rules

With fall arriving and winter just around the corner, many medical organizations are experiencing an increase in immunization-related appointments and procedures. Coding and billing for immunizations is complex, and it’s easy to make costly mistakes that eat up time and revenue.

RCxRules makes it simple to stay on top of ever-changing immunization billing and coding requirements. To guarantee accurate reimbursement for immunizations in the most efficient way, organizations should leverage the RCxRules Revenue Cycle Engine and employ the best practice rules detailed below:

Missing Immunization Procedure Code Rule

This rule is simple and corrects a frequently made mistake. If an immunization admin fee is billed on the encounter but no immunization procedure code is present, this rule will identify it and send a task for review.

Missing Immunization Admin Fee Rule

This rule fires if there is an immunization and there is no administrative code present on the encounter. In the case of pediatric immunizations, if counseling is assumed, the issue can be automatically corrected. If counseling is not assumed, then a user will need to decide which primary administrative code is applicable.

Verification of Units Rule

Units should equal the number of immunizations on the encounter. If they do not, then this rule will automatically update the units accordingly.

Some immunizations have more than one component. This is where there is more than one antigen in a single injection or intranasal/oral immunization. For example, the MMR vaccine contains antigens for Measles, Mumps, and Rubella, which this rule accounts for.

Add & Link Z23 Rule

If Z23 is on the charge this rule will link it to all the immunization admin codes. If Z23 is not on the charge this rule will add the Z23 if there are less than 12 diagnosis codes, and link it to all the immunization admin codes.

If Z23 is needed for immunization and admin codes but there are 12 diagnosis codes on the encounter, this rule will prompt the user to remove one of the 12 existing diagnosis codes and add Z23.

To learn more about how RCxRules can help simplify immunization billing and coding to allow for more accurate and timely reimbursement, set up a 1:1 meeting today.

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