How To Use CPT Code 90688

CPT 90688 refers to the administration of a quadrivalent influenza virus vaccine for intramuscular use. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90688 procedures.

1. What is CPT 90688?

CPT 90688 is a medical billing code used to describe the administration of a quadrivalent influenza virus vaccine for intramuscular use. This vaccine is designed to provide immunity against four strains of the influenza virus, a severe and infectious respiratory disease. The code is used by healthcare providers to bill for the vaccine administration and is essential for accurate medical billing and reimbursement.

2. 90688 CPT code description

The official description of CPT code 90688 is: “Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use.”

3. Procedure

The 90688 procedure involves the following steps:

  1. Provider reviews the patient’s medical history and determines the need for the quadrivalent influenza vaccine.
  2. Provider discusses the risks, benefits, and potential side effects of the vaccine with the patient, guardian, or parent.
  3. Patient is appropriately prepped for the vaccine administration.
  4. Provider injects the 0.5 mL dose of the quadrivalent, split virus, influenza vaccine into the deltoid muscle of the upper arm or anterolateral aspect of the thigh.
  5. Provider monitors the patient for any immediate adverse reactions and provides post-vaccine care instructions.

4. Qualifying circumstances

Patients eligible to receive CPT code 90688 services include those who:

  • Are at least six months of age, as the vaccine is not recommended for younger infants.
  • Have not had a severe allergic reaction to a previous dose of the influenza vaccine or any of its components.
  • Are not currently experiencing a moderate to severe illness with fever, as vaccination should be postponed until the patient has recovered.
  • Are not pregnant, as the safety of the quadrivalent influenza vaccine during pregnancy has not been established.

5. When to use CPT code 90688

It is appropriate to bill the 90688 CPT code when a healthcare provider administers the quadrivalent influenza virus vaccine to an eligible patient for the purpose of providing immunity against four strains of the influenza virus. This code should be used for each administration of the vaccine, regardless of the number of doses required for full immunization.

6. Documentation requirements

To support a claim for CPT 90688, healthcare providers must document the following information:

  • Patient’s age and medical history, including any contraindications to the vaccine.
  • Discussion of risks, benefits, and potential side effects with the patient, guardian, or parent.
  • Preparation of the patient for vaccine administration, including the site of injection.
  • Administration of the 0.5 mL dose of the quadrivalent, split virus, influenza vaccine.
  • Monitoring of the patient for any immediate adverse reactions and provision of post-vaccine care instructions.

7. Billing guidelines

When billing for CPT code 90688, healthcare providers should follow these guidelines:

  • Report separate codes for the vaccine administration, the actual vaccine, and an office visit if applicable.
  • Include sufficient documentation from the provider explaining the product administered, administration route, and purpose.
  • Ensure that the patient meets the qualifying circumstances for receiving the vaccine.
  • Verify that the vaccine administration is medically necessary and supported by the patient’s medical history and documentation.

8. Historical information

CPT 90688 was added to the Current Procedural Terminology system on January 1, 2014. There have been changes to the code descriptor in 2016 and 2017, with the most recent descriptor being “Influenza virus vaccine, quadrivalent (IIV4), split virus, 0.5 mL dosage, for intramuscular use.”

9. Similar codes to CPT 90688

Five similar codes to CPT 90688 and how they differentiate are:

  • CPT 90686: This code is for a trivalent influenza vaccine, which protects against three strains of the virus instead of four.
  • CPT 90687: This code is for a quadrivalent influenza vaccine administered to children between 6-35 months of age, with a smaller dosage of 0.25 mL.
  • CPT 90689: This code is for a cell-culture based quadrivalent influenza vaccine, which uses a different production method than the split virus vaccine.
  • CPT 90756: This code is for a recombinant quadrivalent influenza vaccine, which is produced using a different technology than the split virus vaccine.
  • CPT 90685: This code is for a quadrivalent influenza vaccine administered intradermally, rather than intramuscularly.

10. Examples

Here are 10 detailed examples of CPT code 90688 procedures:

  1. A 30-year-old patient with no contraindications receives the quadrivalent influenza vaccine in the deltoid muscle of the upper arm.
  2. A 65-year-old patient with a history of chronic obstructive pulmonary disease (COPD) receives the quadrivalent influenza vaccine in the anterolateral aspect of the thigh.
  3. A 45-year-old patient with diabetes receives the quadrivalent influenza vaccine in the deltoid muscle of the upper arm.
  4. A 5-year-old child with asthma receives the quadrivalent influenza vaccine in the anterolateral aspect of the thigh.
  5. A 25-year-old patient with no contraindications receives the quadrivalent influenza vaccine in the deltoid muscle of the upper arm during an annual physical exam.
  6. A 50-year-old patient with a history of heart disease receives the quadrivalent influenza vaccine in the anterolateral aspect of the thigh.
  7. A 40-year-old patient with a history of seasonal allergies receives the quadrivalent influenza vaccine in the deltoid muscle of the upper arm.
  8. A 20-year-old college student receives the quadrivalent influenza vaccine in the anterolateral aspect of the thigh during a campus health clinic visit.
  9. A 55-year-old patient with a history of rheumatoid arthritis receives the quadrivalent influenza vaccine in the deltoid muscle of the upper arm.
  10. A 70-year-old patient with a history of cancer receives the quadrivalent influenza vaccine in the anterolateral aspect of the thigh during a follow-up visit with their oncologist.

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