Pediatric Coding Alert

Answer: The first question is whether your doctor administered the DTaP (90700) or the Tdap (90715) to the 8 year old patient. Usually younger children receive the DTaP whereas kids in the eight year old age range typically get the Tdap because it has less of the diphtheria component than the vaccines for younger children get.

 

If your eight-year-old patient was given the Tdap and the IPV vaccines, the correct codes to use would be 90713 (Poliovirus vaccine, inactivated [IPV], for subcutaneous or intramuscular use) for the IPV and 90715 (Tetanus, diphtheria toxoids and acellular pertussis vaccine [Tdap], when administered to individuals 7 years or older, for intramuscular use) for the Tdap.

 

You might face some payment challenges for administering the Tdap vaccine. For example, Aetna’s policy states, “Aetna considers the Tdap vaccine a medically necessary preventive service for immunization against tetanus, diphtheria, and pertussis as a single dose in all individuals 65 years of age and older and in pregnant women regardless of prior vaccination history, or in women immediately postpartum if not administered during pregnancy. Aetna considers the Tdap vaccine a medically necessary preventive service for immunization against tetanus, diphtheria, and pertussis as a single dose in children 7 through 10 years of age with incomplete or unknown pertussis vaccine history.”

 

This policy seems to indicate that unless your patient has an incomplete or unknown pertussis vaccine history, the vaccination may not be payable. However, you should contact the insurer and let them know the situation (for example, if the child missed prior scheduled vaccines when he was younger) to determine the best payment method.