Pediatric Coding Alert

Question: What does the lightening-bolt symbol next to CPT 90680 mean?


Alabama Subscriber


Answer: The symbol that looks like a lightening bolt in front of 90680 (Rotavirus vaccine, pentavalent, 3-dose schedule, live, for oral use) indicates that the product the code represents is still awaiting U.S. Food and Drug Administration approval.

"The CPT Editorial Panel, in recognition of the public health interest in vaccine products, has chosen to publish new vaccine product codes prior to FDA approval," states the AMA in the introductory notes to the "Vaccines, Toxoids" subsection. Although the designation was valid when the CPT 2006 manual came out last fall, approval has since been granted.

You should use 90680 for RotaTeq (rotavirus vaccine, live, oral, pentavalent), which the FDA approved on Feb. 3, 2006. The vaccine by Merck & Co. Inc. is now available at most pediatricians' offices and is delivered by mouth.

Because the oral vaccine is usually given to a child in three doses, at well-baby visits at ages 2, 4 and 6 months (preventive medicine service codes 99381, Initial ... [age under 1 year] or 99391, Periodic ...) , you will usually code the administration with 90467-90468, Immunization administration under age 8 years [includes intranasal or oral routes of administration] when the physician counsels the patient/family ...).

If the physician does not provide vaccine counseling, use 90473-90474, Immunization administration by intranasal or oral route ...).

"It is the only vaccine available in the United States for use against rotavirus gastroenteritis, a common childhood illness that is the single largest infectious disease killer of infants and young children worldwide," according to a September press release from The Children's Hospital of Philadelphia.

Warning: The "catalog price" of $62.50 a dose might make it prohibitive to administer this vaccine, "at least until pediatricians confirm that insurance companies are going to pay for RotaTeq," writes Vincent Iannelli, MD, FAAP, associate professor of pediatrics at the University of Texas Southwestern Medical School, in "RotaTeq Rotavirus Vaccine" published by About Inc.

Aetna does cover 90680 with V04.89 (Need for prophylactic vaccination and inoculation against other viral diseases) for the Rotavirus vaccine. "Aetna considers rotavirus vaccine (Rotateq) a medically necessary service for prevention of rotavirus gastroenteritis in infants," according to Aetna's Clinical Policy Bulletin #0723, dated April 4, 2006. But individual plans may not pay for preventive vaccines if the policies exclude coverage of preventive services.

For up-to-date information on codes with the lightening-bolt symbol, refer to the AMA site
www.ama-assn.org/ama/pub/category/10902.html.

Answers to You Be the Coder and Reader Questions reviewed by Richard H. Tuck, MD, FAAP, a pediatrician at PrimeCare of Southeastern Ohio in Zanesville.