Pediatric Coding Alert

One of the new vaccine codes for 1998 is 90748, for the combined immunization of hepatitis B and Hemophilus Influenza B (Hib). This is the only new immunization code, but there are always new combinations under development. The problem is that these vaccines may be approved and released during the year, before there are any new codes for them. When this happens, the only choice pediatric coders have is to use 90749 (unlisted immunization procedure), which is not nearly as easily reimbursable as a specific code. The American Medical Association (AMA) is working with the Centers for Disease Control and the AAP to get new codes for new vaccines in the works sooner, and, in fact, to improve the entire immunization section of the CPT book.

Were trying to keep everything up to date, says Mary OHeron, senior research associate at the AMA. If it appears that the Food and Drug Administration is going to approve a vaccine during the year, before the new CPT cycle (which occurs sometime in May, with the book actually being released in late November and the codes going in effect the following January), the AMA will get a code for it. That is what happened with the varicella vaccine (90716).

New immunization codes that will be considered for the 1999 CPT book are rotavirus, hepatitis A and hepatitis B, Lyme disease, and -- of great interest to pediatricians -- a combination DTaP and polio vaccine.

The DTaP/Polio vaccine code would replace 90711 (DTP/Polio), which isnt used anymore. (Fewer children experience side effects from DTaP). But if anyone is going to be using DTaP/Polio this year, before there is a code for it, they will have to use CPT 90749 , says OHeron.

She acknowledges that the code can cause problems in terms of managed care, but notes that because of immunization registries, it is essential to use the correct code. For example, dont try to use two codes, such as for DTaP (90700) and Polio (90713), if you just give one injection using a combination vaccine. That type of reporting -- breaking out the vaccines -- is not recommended, states OHeron firmly, as all your insurance claims are also collected by the CDC to track immunization disease rates.