How To Use CPT Code 90698

CPT 90698 refers to the administration of a combination vaccine for diphtheria, tetanus, pertussis, Haemophilus influenzae type b, and poliovirus. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90698.

1. What is CPT 90698?

CPT 90698 is a medical billing code used to describe the administration of a combination vaccine that protects against diphtheria, tetanus, pertussis (whooping cough), Haemophilus influenzae type b (Hib), and poliovirus. This vaccine is administered intramuscularly and is typically given to infants and children as part of their routine immunization schedule.

2. 90698 CPT code description

The official description of CPT code 90698 is: “Diphtheria, tetanus toxoids, acellular pertussis vaccine, Haemophilus influenzae type b, and inactivated poliovirus vaccine, (DTaP-IPV/Hib), for intramuscular use.”

3. Procedure

1. The healthcare provider reviews the patient’s medical history and discusses the benefits, risks, and potential side effects of the vaccine with the patient or their guardian.
2. The patient is appropriately prepped for the vaccine administration.
3. The healthcare provider administers the DTaP-IPV/Hib vaccine intramuscularly, typically in the thigh or deltoid muscle of the upper arm.
4. The vaccine is given in a series of three to four doses, depending on the brand, to ensure the development of strong immunity.
5. After the vaccine administration, the healthcare provider monitors the patient for any immediate adverse reactions and provides post-vaccine care instructions.

4. Qualifying circumstances

Patients eligible to receive CPT code 90698 services are infants and children who require immunization against diphtheria, tetanus, pertussis, Hib, and poliovirus. The vaccine is typically administered as part of the routine immunization schedule, with the first dose given at 2 months of age, followed by additional doses at 4 months, 6 months, and 15-18 months. In some cases, a booster dose may be given at 4-6 years of age. Healthcare providers should follow the recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Centers for Disease Control and Prevention (CDC) for the appropriate administration of this vaccine.

5. When to use CPT code 90698

It is appropriate to bill the 90698 CPT code when a healthcare provider administers the DTaP-IPV/Hib vaccine to an eligible patient as part of their routine immunization schedule. The code should be used for each dose of the vaccine given, and it should be billed along with separate codes for vaccine administration and an office visit, if applicable.

6. Documentation requirements

To support a claim for CPT 90698, healthcare providers must document the following information:

• Patient’s age and immunization history
• Date of vaccine administration
• Vaccine manufacturer, lot number, and expiration date
• Site and route of vaccine administration
• Name, title, and professional credentials of the person administering the vaccine
• Any adverse reactions or side effects experienced by the patient

7. Billing guidelines

When billing for CPT code 90698, healthcare providers should follow these guidelines:

• Report separate codes for vaccine administration, the actual vaccine, and an office visit, based on the documentation.
• Include sufficient documentation to support the claim, such as the product administered, administration route, and purpose.
• Check with individual payers for their specific guidelines on reporting vaccines, as Medicare and private insurance companies may have different requirements.
• Be aware of any payer-specific policies regarding the use of modifier 25 for the associated evaluation and management (E/M) code.

8. Historical information

CPT 90698 was added to the Current Procedural Terminology system on January 1, 2004. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2017.

9. Similar codes to CPT 90698

There are several other CPT codes related to combination vaccines that differentiate from CPT 90698:

• CPT 90696: DTaP-IPV vaccine, which does not include the Hib component
• CPT 90700: DTaP vaccine, which does not include the IPV and Hib components
• CPT 90701: DTP vaccine, which contains whole-cell pertussis instead of acellular pertussis
• CPT 90702: DT vaccine, which does not include the pertussis, IPV, and Hib components
• CPT 90703: Tetanus toxoid vaccine, which only protects against tetanus

10. Examples

Here are 10 detailed examples of CPT code 90698 procedures:

1. A 2-month-old infant receives their first dose of the DTaP-IPV/Hib vaccine during a well-child visit.
2. A 4-month-old infant receives their second dose of the DTaP-IPV/Hib vaccine as part of their routine immunization schedule.
3. A 6-month-old infant receives their third dose of the DTaP-IPV/Hib vaccine during a scheduled immunization appointment.
4. A 15-month-old child receives their fourth dose of the DTaP-IPV/Hib vaccine as part of their routine immunization schedule.
5. A 4-year-old child receives a booster dose of the DTaP-IPV/Hib vaccine before starting preschool.
6. A healthcare provider administers the DTaP-IPV/Hib vaccine to a child with a history of incomplete immunization.
7. A child with a contraindication to the whole-cell pertussis vaccine receives the DTaP-IPV/Hib vaccine as an alternative.
8. A healthcare provider administers the DTaP-IPV/Hib vaccine to a child during an international adoption process.
9. A child with a high risk of exposure to Haemophilus influenzae type b receives the DTaP-IPV/Hib vaccine as part of their immunization plan.
10. A healthcare provider administers the DTaP-IPV/Hib vaccine to a child following the ACIP and CDC recommendations for catch-up immunization.