Pediatric Coding Alert

Question: I am confused about the correct administration code to use for the third pediatric dose of the Pfizer-BioNTech tris-sucrose vaccine. Should I be using 0054A?

Vermont Subscriber

Answer: According to the AMA’s most recent guidance, 0054A (Immunization administration by intramuscular injection of … [COVID-19 vaccine], mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; booster dose) should not be used for the third pediatric dose of the vaccine.

Instead, on Jan. 12, the AMA authorized use of 0073A (Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation; third dose) to reflect the lower pediatric dose of the Pfizer-BioNTech tris-sucrose vaccine.

The code should be used in conjunction with 91307 (Severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) (coronavirus disease [COVID-19]) vaccine, mRNA-LNP, spike protein, preservative free, 10 mcg/0.2 mL dosage, diluent reconstituted, tris-sucrose formulation, for intramuscular use). Administration of the first and second doses of 91307 should be coded with 0071A (… first dose) and 0072A (… second dose) respectively.

Remember this age range for 91307: You should reserve use of this dosage and associated product and administration codes for “patients ages 5 through 11 years of age,” per CPT^® Assistant Special Edition October Update Volume 31, 2021 (Source: www.ama-assn.org/system/files/cpt-assistant-guide-coronavirus-october-2021.pdf).

For patients 11 and up, you will document the higher-dose Pfizer-BioNTech tris-sucrose vaccine using 91305 (… [COVID-19 vaccine], mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, trissucrose formulation, for intramuscular use) with administration codes 0051A (Immunization administration by intramuscular injection of … [COVID-19] vaccine, mRNA-LNP, spike protein, preservative free, 30 mcg/0.3 mL dosage, tris-sucrose formulation; first dose), 0052A (… second dose), 0053A (… third dose), and 0054A (… booster dose) as we previously reported in Pediatric Coding Alert Volume 25, Number 1, 2022.