Pediatric Coding Alert

Question: My pediatrician wants to purchase preservative-free tetanus diphtheria (Td) vaccine. Does a CPT Codes exist for this product?


Pennsylvania Subscriber

Answer: Yes. CPT contains a code for Sanofi Aventis (previously Aventis Pasteur) new preservative-free Td vaccine called DECAVAC. When your office gives this injection, you should report 90714 (Tetanus and diphtheria toxoids [Td] adsorbed, preservative-free, for use in individuals 7 years or older, for intramuscular use), in addition to 90471-90474 (Immunization administration ...).

Catch: The CPT manual won't contain 90714 until 2006, but the code becomes effective July 1, 2005. Some health plans indicate that they will accept the code earlier than the HIPAA implementation deadline.

Action: Prior to purchasing preservative-free Td vaccination, contact your insurers for 90714 activation information. If an insurance representative is unaware of the new code, e-mail or fax her CPT's early-release vaccine code information available online at www.ama-assn.org/ama/pub/category/10902.html.

Alternative: If a health plan is not ready to receive claims containing 90714, you should instead report 90749 (Unlisted vaccine/toxoid). But only default to the unlisted-procedure code when the insurer also won't accept claims with a date of service prior to the new Td code's implementation date.

Best practice: Because reimbursement is uncertain, you should have the patient or patient's guardian sign an advance beneficiary notice (ABN). Explain that the patient will be responsible for payment if the insurer denies payment. For a sample ABN, appeal letter and more information on appropriate reimbursement for DECAVAC vaccine, visit VaccineShoppe.com within the virtual "Library" under "Reimbursement Information."

Eligibility: You may administer the Td vaccine under two conditions: