Version 21.3

Overview

Synagis (palivizumab), the traditional seasonal monoclonal antibody against respiratory syncytial virus, is not technically a vaccination, being a passive immunization. 

That said, it is vaccine-like in several ways: 

• It provides passive immunity for an infectious disease.
• Infectious disease guidemaking bodies (e.g. ACIP, AAP) have issued recommendations for its use in infectious disease prevention.
• It has a CVX code, 93.

Immunization registries thus take various positions on whether Synagis should be reported to a state immunization registry. Depending on whether your state wants Synagis reported to your state immunization registry, you have three options for documenting its administration in Office Practicum: 

In this example, we will show three ways of documenting administration of Synagis to an infant within OP: Option A, Option B, and Option C. 

• The first example will be the straightforward administration of 100 mg of Synagis from a single dose in a single injection. 
• The second example will be more complicated: 138 mg of Synagis given. Typically, this would be delivered in two divided doses, an entire 100 mg vial and part of a 50 mg vial. 

Each of Option A, B and C has pros and cons, which are summarized in the table at the end.

Option A: Document Synagis Like A Vaccine

Example 1: 100 mg Dose

1. Enter a lot of Synagis into your vaccine inventory:

1. Choose from inventory to administer:

1. Fill in the administration details, making sure the Add vaccine to superbill box is checked, and then save:

Example 2: 138 mg Dose

Typically for a patient receiving between 100 mg and 150 mg, you’ll receive two vials, a 100 mg vial and a 50 mg vial. These will need to be entered separately into your vaccine inventory.

1. First, enter into the 100 mg vial into your vaccine inventory:

1. Second, enter the 50 mg vial into your vaccine inventory:

1. Once the vaccine has been administered, choose from inventory to document:

1. Fill in the administration details and Save:

1. Because OP won’t let you enter more than one dose into the vaccine inventory in a day, and the 100 mg lot number is different than the 50 mg lot number, the 50 mg vial will need to be deducted manually, like this: 
   • In the lot of 50 mg vials, increment the Doses used by 1,
   • Then add a note in the Notes section:

1. Now go into the chart and edit the dose to reflect the correct dose and lot numbers given and document the administration sites:

1. Enter in the correct volume (in mL). 
   • Because it is over 1 mL, is separate lot numbers, and given in a divided dose, document that and body site in “comments” and save:

1. Because you have “edited” the volume that was originally sent to the superbill when the vaccine was documented, your superbill will need to be adjusted:

1. Change the number of units from 1 to 3:

1. (Optional) Depending on your state registry requirements, you may need to let the registry know that both 100 mg and 50 mg vials were used and they may also need to manually decrement the 50 mg vial.

Option B: Document Synagis Like a Non-Vaccine Injectable

Example 1: 100 mg Dose

1. Open the encounter note, go to Plan, and use a pretemplated Medicine given label from Phrase Construction such as this:

1. Complete the empty fields as appropriate.
2. Then enter in the appropriate diagnosis code. Typically, Z29.11 is used:

1. Add in the appropriate CPT codes and number of units given:

Example 2: 138 mg Dose

1. Open the encounter note, go to Plan, and use a pretemplated Medicine given label from Phrase Construction such as this:

1. Complete the empty fields as appropriate.
2. Then enter in the appropriate diagnosis code. Typically, Z29.11 is used:

1. Add in the appropriate CPT codes and number of units given:

Option C: Document Using A Template

Example 1: 100 mg Dose

1. Open a new encounter and choose the appropriate template:

1. Leave the Synagis encounter diagnosis (Z29.11) already present in the template. Depending on your payer preference, you may also need to add one that explains why the child is getting Synagis, e.g. prematurity, congenital heart disease, etc:

1. Fill in the reason in the Assessment tab:

1. Fill in the administration details in the Plan tab:

1. Save the note. Billing for this method is similar to Option B.

Example 2: 138 mg Dose

1. Open a new encounter and choose the appropriate template:

1. Leave the Synagis encounter diagnosis (Z29.11) already present in the template. Depending on your payer preference, you may also need to add one that explains why the child is getting Synagis, e.g. prematurity, congenital heart disease, etc:

1. Fill in the reason in the Assessment tab:

1. Fill in the administration details in the Plan tab:

1. Save the note. Billing for this method is similar to Option B.

Table: What Option is Best for My Practice?

There may not be a "best" option for all practices. We encourage each practice to evaluate the pros and cons of each method, then use that method for all Synagis administrations going forward: