Billing code being used as tool to vaccinate more Pennsylvanians

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SCRANTON, LACKAWANNA COUNTY (WRBE/WYOU) — Questions are being raised about the privacy of patients amid the pandemic.

These questions come after the state’s physician general notified health care providers about a billing code to be used for those who refuse the vaccine after receiving counseling.

To clarify, the billing code is used for all vaccines, but most recently the COVID-19 vaccine was added. The state’s acting physician general says it’s a tool to vaccinate more Pennsylvanians

Late last week, the State Health Department sent out a letter to doctors and hospitals with a new COVID direction. The letter can be viewed below.

The state wants healthcare providers to report an individual’s COVID vaccination status.

It would be tracked by a billing code. The code technically is for ‘COVID vaccination counseling’ a discussion between the doctor and the patient.

What it really means is a patient’s vaccination status is being reported.

“It allows a dialogue between the professional and the patient to determine whether or not the vaccine is the appropriate course for them,” said Dr. Edward Zurad, Family Physician.

Dr. Zurad says Medical code ‘Z28.20’ is not a new code. It’s used when a patient refuses a vaccine whether it be for something like shingles, tetanus, and now COVID.

It’s defined under the code as an ‘immunization not carried out because of patient decision for an unspecified reason.’

When asked why he believes the Department of Health (DOH) is pushing for the code, Dr. Zurad responded, “I think the real reason is because of the new availability of COVID vaccine for children ages five to 11.”

More than 72 percent of the state’s adult population is now vaccinated against COVID-19.

The acting physician general’s letter says, “This new code will allow us to follow vaccine counseling visits, and take more steps to vaccinate Pennsylvanians.”

However, that’s a different statement Eyewitness News received from the DOH.

When asked if the code would be used to track who has the vaccine and who doesn’t, the DOH told Eyewitness News, “To be clear, the state is not receiving or tracking any information from this effort. The amount of reimbursement is determined by the insurers.”

You can read the Department of Health’s response to the letter below:

Neither DHS or DOH are receiving medical information about patients. The code is similar to those used by health care providers to inform insurance companies about patient services for the purposes of determining insurance coverage. This is a code that can be added to a visit when a provider submits their normal billing information, which signifies that vaccine counseling occurred during the visit. Providers may talk to patients about the possible side effects and benefits of getting vaccinated, and ensure that patients have the most accurate information available when deciding whether or not to get vaccinated. There is no HIPAA concern because no medical information is being shared outside of the typical existing patient, doctor and insurer circle. DOH and DHS will not reach out to patients to follow-up. MCOs may, at their discretion, use this information to compensate providers for the extra time spent with patients to counsel them regarding COVID-19 vaccination status as an added incentive for doing vaccine counseling. To be clear, the state is NOT receiving or tracking any information from this effort. The amount of reimbursement is determined by the insurers.

While the Department of Health says the code doesn’t kick off tracking, the fact that a provider notes it on your health record means the information is being stored, and in some cases shared with insurance companies. Also based on the acting physician general’s letter, the code will be used to take steps to vaccinate citizens.

“We’d still bill that code if indeed part of the only reason for the visit. Many times physicians are having that discussion as part of a regular visit for some other acute condition or a wellness exam,” said Dr. Zurad

Eyewitness News was told this Z-code was created for pediatrics visits for parents to learn more about vaccines and has grown over the years for adult vaccines as well.

Copyright 2021 Nexstar Media Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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