How to report adverse effects of vaccination?

Answered by Arslan Suleymanov, medical reimbursement specialist, editor-in-chief of WCH Insights:
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 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.