Internal Medicine Coding Alert

Question: I know that, as of the first of the year, code 90718 has been deleted.  I have found instructions to use 90714 instead, but the code descriptor specifies that the vaccine is preservative free. This seems like incorrect billing if ours is not a preservative free vaccine.  What’s your advice?

Florida Subscriber

Answer:  You’re correct in your research. Code 90718 (Tetanus and diphtheria toxoids [Td] adsorbed when administered to individuals 7 years or older, for intramuscular use) was deleted effective January 1, 2013. CPT^® guidelines direct you to report 90714 (Tetanus and diphtheria toxoids [Td] adsorbed, preservative free, when administered to individuals 7 years or older, for intramuscular use).

Code 90714 applies to all your cases because all TD vaccines on the market in the U.S. are considered preservative-free (which means they contain only trace amounts of preservative). CPT^® defines preservative free as follows: “The term ‘preservative free’ includes use for vaccines that contain no preservative and vaccines that contain trace amounts of preservative agents that are not present in a sufficient concentration for the purpose of preserving the final vaccine formulation. The absence of a designation regarding a preservative does not necessarily indicate the presence or absence of preservative in the vaccine.”