Primary Care Coding Alert

Question:

We started receiving Prevnar 13 vaccine instead of Prevnar 7. Do I use the same coding?

Ohio Subscriber

Answer:

You will switch the CPT code you use from 90669 (Pneumococcal conjugate vaccine, 7 valent, for intramuscular use) to 90670 (Pneumococcal conjugate vaccine, 13 valent, for intramuscular use). Prevnar 13 (PCV13) replaces Prevnar 7 (PCV7). Prevnar 13 adds protection against six more strains of the pneumococcal bacteria, according to The New York Times.

Keep these points in mind for proper reporting and reimbursement:

The corresponding V code is V03.82 (Other specified vaccinations against single bacterial diseases; streptococcus pneumoniae [pneumococcus]).

With implementation underway, start contacting your payers about recognition and appropriate payment. It's a tedious task, but important for every group.

As with the older vaccine, Prevnar 13 is given by intramuscular injection (Immunization administration code: 90465, +90466, 90471, or +90472) at 2 months, 4 months, 6 months (corresponding with infant preventive medicine service code 99381 (new patient) or 99391 (established patient), and between 12 and 15 months of age (corresponding with early childhood preventive medicine service code 99382 (new patient) or 99392 (established patient)).

An immunization advisory committee for the Centers for Disease Control and Prevention recommended that all children less than 5 years of age who received the Prevnar 7 vaccine should get a supplemental dose of Prevnar 13 the next time they visit the doctor, up to 59 months of age.