ICD-10-CM Coding for Haemophilus influenzae
Here’s a clear and thorough guide for medical coding and billing for Haemophilus influenzae (H. influenzae) — not to be confused with the flu (influenza virus). This bacterium can cause serious invasive diseases like meningitis, epiglottitis, pneumonia, and sepsis.
Common ICD-10 Diagnosis Codes:
| ICD-10 Code | Description |
|---|---|
| A41.3 | Sepsis due to Haemophilus influenzae |
| G00.0 | Haemophilus influenzae meningitis |
| J14 | Pneumonia due to Haemophilus influenzae |
| J05.1 | Acute epiglottitis |
| J20.3 | Acute bronchitis due to H. influenzae |
| H66.3 | Otitis media due to H. influenzae |
| A49.2 | H. influenzae infection, unspecified site |
Vaccination Coding for Hib (Haemophilus influenzae type b)
Vaccination is specifically for Hib, primarily in pediatric populations.
CPT Codes – Hib Vaccine:
| CPT Code | Description |
|---|---|
| 90644 | Hib-Hep B vaccine (combined) |
| 90645 | Hib vaccine, PRP-D conjugate |
| 90646 | Hib vaccine, PRP-OMP conjugate |
| 90647 | Hib vaccine, PRP-T conjugate |
| 90648 | Hib vaccine, PRP-T conjugate (different brand) |
Vaccine Administration Codes:
| Code | Description |
|---|---|
| 90460 | Vaccine admin with counseling (0–18 years, first vaccine) |
| 90461 | Admin for each additional component |
| 90471/90472 | Admin codes without counseling (used in adults or no counseling) |
Diagnosis Code for Immunization:
Z23 – Encounter for immunization
Billing Tips
When treating H. influenzae infection:
Use the most specific ICD-10 code (e.g., J14 for pneumonia).
Document organism identification (via culture or PCR).
If multiple complications are present, code each condition (e.g., meningitis and sepsis).
When billing for Hib vaccine:
Use Z23 as the primary diagnosis.
Ensure proper documentation of:
Manufacturer, lot number
Route, site of administration
Parent/guardian consent
Counseling (if billing 90460/90461)
Clinical and Coding Scenarios
Example 1: Hib Meningitis
ICD-10: G00.0
Supporting codes: Fever (R50.9), seizures (R56.9) if present
Example 2: Hib Pneumonia
ICD-10: J14
Avoid generic pneumonia codes unless cause is unknown
Example 3: Well-child visit with Hib vaccine
CPT: 90648
Admin: 90460 (if counseling given)
ICD-10: Z23 + Z00.129 (routine child visit)
Compliance & Documentation Tips
Use lab confirmation if billing for a specific organism (especially G00.0 or A41.3).
Avoid generic infection codes when a specific bacterial etiology is documented.
When giving the Hib vaccine:
Include documentation of education/counseling if using 90460
Include Z23 in diagnosis
Check payer-specific policies: Some Medicaid/CHIP plans have unique guidelines for vaccine billing
Summary Coding Table
| Condition | ICD-10 Code | CPT Code (if vaccinated) |
|---|---|---|
| Hib Meningitis | G00.0 | — |
| Hib Pneumonia | J14 | — |
| Hib Sepsis | A41.3 | — |
| Hib Otitis Media | H66.3 | — |
| Hib Vaccine | Z23 | 90645–90648 + admin |