Pediatric Coding Alert

Question: Are there monkeypox vaccine codes for children? We haven’t seen any monkeypox at our practice yet, but parents are starting to ask about it, so my colleagues and I want to be prepared.

Oregon Subscriber

Answer: Yes, there are. The timing is such that you might not find them in the AMA code book until CPT^® 2024 comes out, but the three codes themselves are effective now.

The three codes are:

• 87593 (Infectious agent detection by nucleic acid (DNA or RNA); orthopoxvirus (eg, monkeypox virus, cowpox virus, vaccinia virus), amplified probe technique, each)
• 90611 (Smallpox and monkeypox vaccine, attenuated vaccinia virus, live, non-replicating, preservative free, 0.5 mL dosage, suspension, for subcutaneous use)
• 90622 (Vaccinia (smallpox) virus vaccine, live, lyophilized, 0.3 mL dosage, for percutaneous use)

Code 87593 is the test code, so if the patient tests positive for monkeypox, you’ll also need to report diagnosis code B04 (Monkeypox). Also, be aware that 90611 is only for patients 18 years or older, so most of your patients won’t likely use this one. CPT^® 90622 is for patients 12 months and older. The expanded access Investigational New Drug (IND) application allows its use against monkeypox. In other words, the FDA is allowing the “compassionate use” of IND products outside of clinical trials —in this case ACAM2000 — to expand access for certain patients who have no alternative options.

There are currently no new administration codes for 90611and 90622, so you should choose from the following existing codes:

• 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered)
• + 90461 (… each additional vaccine or toxoid component administered (List separately in addition to code for primary procedure))
• 90471 (Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid)
• +90472 (… each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure))

Pay close attention to the descriptors when selecting the correct administration code. Age, administration method, provider qualifications, and encounter specifics are going to dictate which code(s) you’ll need.