Pediatric Coding Alert

In the story on new CPT codes for 1999 in the November issue of PCA (81-82), we omitted 90718. That is the code for Tdtetanus and diphtheria toxoids for adult use. Thats what it says in CPT, and thats what it says on the vaccine. But Td is actually supposed to be given to 11- to 12-year-olds if they are up to date on their immunizations and it can be given even earlier if they arent. The Advisory Committee on Immunization Practices, the American Academy of Pediatrics, and the American Academy of Family Physicians all recommend giving Td at age 11-12.

It is 90702 (DT) which is specified in CPT for pediatric use, but as can be seen, both 90702 and 90718 could be used in pediatric practices. Therefore, we should have included 90718 in the list of new immunization codes. However, pertussis vaccine is usually given with diphtheria and tetanus vaccine for all of the earlier immunizations; either DTaP (90700) or DTP (90701).

This is an important clarification, because there are many insurance companies that are making the same mistake of thinking 90718 is only for adults, according to Ann Luzier, office manager for Pediatric Associates of Washington, a two-pediatrician practice in Washington, PA. Some understand we use the 90718, says Luzier. But some insurance companies dontand they wont pay.

Even Pennsylvania, which pays the practice for administration of vaccines to Medicaid-covered patients or the uninsured, was not recognizing 90718which means Luzier wasnt getting the $10 administration fee per shot. When we were filing 90718, they were saying it wasnt an appropriate code, that it was for adult use only, she says, adding, When it was only a $2.50 administration fee, we wrote it off. But when the state raised it to $10, the practice would have been losing a substantial amount of revenue by writing off that amount. So Luzier fought it. Nobody had ever questioned it [the rejection of the 90718 code], but we did, she relates. With the help of the AAP, the appropriate higher-level state official was reached. Now Pennsylvania, with the help of the AAP and the federal Vaccines for Children program, is negotiating with Medicaid to rectify the situation. Im trying to get everyone on the same page here, Luzier adds.