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:
  Preventive: as a routine booster (V06.5, Need for prophylactic vaccination and inoculation against combinations of diseases; tetanus-diphtheria [Td] [DT]) every 10 years throughout life for patients 7 years of age or older who have received a primary series of tetanus- and diphtheria-containing vaccine
  Therapeutic: for wound care (such as 892.0, Open wound of foot except toe[s] alone; without mention of complication) in persons who have not received a tetanus toxoid-containing preparation within the preceding five years. Answers to You Be the Coder and Reader Questions provided by Richard Lander, MD, FAAP, pediatrician at Essex-Morris Pediatric Group in Livingston, N.J.; Steven M. Verno, CMBSI, CMMC, CMMB, NREMTP, Medical Association of Billers; and Richard Tuck, MD, FAAP, a member of the American Academy of Pediatrics national committee on coding and nomenclature.