Pediatric Coding Alert

Question: When a patient receives a DECAVAC injection for immunization, should I use CPT 90714 or 90718? Which diagnosis code should I report?


New Jersey Subscriber

Answer: When staff use DECAVAC from Sanofi Aventis, you should use 90714 (Tetanus and diphtheria toxoids [Td] adsorbed, preservative-free, for use in individuals 7 years or older, for intramuscular use) in addition to 90465-90466 (Immunization administration under 8 years of age [includes percutaneous, intradermal, subcutaneous, or intramuscular injections] when the physician counsels the patient/family ...), or if no physician counseling is done or the child is over 8 years of age, 90471-90472 (Immunization administration [includes percutaneous, intradermal, subcutaneous, or intra-muscular injections] ...).

Although both 90714 and 90718 describe toxoids containing tetanus and diphtheria (Td), the first code denotes the preservative-free version, and the latter code represents the regular product. For regular (meaning non- preservative-free) Td products, assign 90718 (Tetanus and diphtheria toxoids [Td] adsorbed for use in individuals 7 years or older, for intramuscular use).

Link the vaccine administration and product code to the reason for Td administration. Use V06.5 (Need for prophylactic vaccination and inoculation against combinations of diseases; tetanus-diphtheria [Td] [DT]) for preventive vaccination.

Other uses: DECAVAC is also approved for wound management in persons 7 years of age and older. For therapeutic administration (in persons who have not received a tetanus toxoid-containing preparation within the preceding five years), you should assign the injectable code with a wound care diagnosis (such as 892.0, Open wound of foot except toe[s] alone; without mention of complication).

Pediatric version: For diphtheria and tetanus toxoids, adsorbed (DT) pediatric, you should instead report the product with 90702 (Diphtheria and tetanus toxoids [DT] adsorbed for use in individuals younger than 7 years, for intramuscular use).

Use the appropriate vaccination administration code (90465-90466 for administration with physician counseling and individuals younger than 8 years, or 90471-90472 for administration when patient is 8 years or older or without physician counseling). You will use the same ICD-9 code as for Td vaccination: V06.5.