ICD-10 Guide

Z29.11

Encounter for prophylactic immunotherapy for respiratory syncytial virus (RSV)

BILLABLE STATUSYes

IMPLEMENTATION DATEOctober 1, 2015

LAST UPDATED09/12/2025

Code Description

ICD-10 Z29.11 is a billable code used to indicate a diagnosis of encounter for prophylactic immunotherapy for respiratory syncytial virus (rsv).

Key Diagnostic Point:

Z29.11 is used to document encounters for prophylactic immunotherapy specifically aimed at preventing respiratory syncytial virus (RSV) infections, particularly in high-risk populations such as premature infants or children with certain underlying health conditions. This immunotherapy, often administered as palivizumab, is crucial in reducing the incidence of severe RSV disease, which can lead to hospitalization and significant morbidity. The use of this code reflects a proactive approach to healthcare, emphasizing preventive care and the importance of immunization in vulnerable populations. Social determinants of health, such as access to healthcare services, socioeconomic status, and living conditions, play a critical role in the effectiveness of such preventive measures. Proper documentation of the patient's risk factors, the rationale for immunotherapy, and any relevant social determinants is essential for accurate coding and reimbursement.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

Need for detailed documentation of patient risk factors
Understanding of specific immunotherapy protocols
Variability in payer requirements for prophylactic treatments
Potential for overlapping diagnoses and codes

Audit Risk Factors

Inadequate documentation of patient eligibility for prophylaxis
Failure to link immunotherapy to specific high-risk conditions
Misunderstanding of payer guidelines for prophylactic treatments
Inconsistent coding practices across different healthcare settings

Specialty Focus

Medical Specialties

Primary Care

Documentation Requirements

Documentation should include patient history, risk factors for RSV, and details of the immunotherapy administered.

Common Clinical Scenarios

Routine checkups for high-risk infants, administration of RSV prophylaxis during flu season.

Billing Considerations

Consideration of social determinants such as family support, access to healthcare, and socioeconomic factors that may affect treatment adherence.

Public Health

Documentation Requirements

Documentation should include population health data, surveillance of RSV cases, and effectiveness of immunotherapy in the community.

Common Clinical Scenarios

Community health initiatives aimed at increasing RSV immunization rates among high-risk populations.

Billing Considerations

Focus on tracking health disparities and ensuring equitable access to preventive services.

Coding Guidelines

Inclusion Criteria

Use Z29.11 When

Z codes are used to indicate encounters for circumstances other than a disease or injury
11 should be used when the primary purpose of the encounter is for prophylactic immunotherapy
It is important to sequence this code appropriately, often following any relevant diagnosis codes that justify the need for immunotherapy
Payer requirements may vary, so it is essential to verify coverage for prophylactic treatments

Exclusion Criteria

Do NOT use Z29.11 When

No specific exclusions found.

Related CPT Codes

90378CPT Code

Palivizumab injection for RSV prophylaxis

Clinical Scenario

Administered during a well-child visit for high-risk infants.

Documentation Requirements

Document the administration details, patient eligibility, and any observed reactions.

Specialty Considerations

Primary care providers should ensure comprehensive documentation of the patient's risk factors.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for greater specificity in coding prophylactic measures, enhancing the ability to track and manage RSV immunotherapy in high-risk populations.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for greater specificity in coding prophylactic measures, enhancing the ability to track and manage RSV immunotherapy in high-risk populations.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for greater specificity in coding prophylactic measures, enhancing the ability to track and manage RSV immunotherapy in high-risk populations.

Resources

Clinical References

•
CDC Guidelines for RSV Prevention

Coding & Billing References

•
CDC Guidelines for RSV Prevention

Frequently Asked Questions

What documentation is required for Z29.11?

Documentation must include the patient's risk factors for RSV, the rationale for administering prophylactic immunotherapy, and any relevant social determinants that may impact the patient's health status.

ICD-10 Z29.11 is a billable code used to indicate a diagnosis of encounter for prophylactic immunotherapy for respiratory syncytial virus (rsv).