How To Use CPT Code 90700

CPT 90700 refers to the administration of the diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP) for individuals younger than 7 years. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90700 procedures.

1. What is CPT 90700?

CPT 90700 is a medical code used to describe the administration of the diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP) for individuals younger than 7 years. This vaccine is administered intramuscularly and is essential for protecting children against these serious diseases.

2. 90700 CPT code description

The official description of CPT code 90700 is: “Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use.”

3. Procedure

The 90700 procedure involves the following steps:

1. The provider discusses the vaccine options, risks, benefits, and potential side effects with the parent, guardian, or patient.
2. The patient is appropriately prepped for the vaccine administration.
3. The provider administers the vaccine intramuscularly in the deltoid muscle of the upper arm or anterolateral aspect of the thigh.
4. The provider documents the vaccine administration, including the product used, administration route, and purpose.

4. Qualifying circumstances

Individuals eligible to receive CPT code 90700 services are children younger than 7 years who require immunization against diphtheria, tetanus, and pertussis. The DTaP vaccine is typically administered in a series of five doses at the following ages: two months, four months, six months, 15 to 18 months, and four to six years. The series should be completed before the child’s seventh birthday.

5. When to use CPT code 90700

It is appropriate to bill the 90700 CPT code when a healthcare provider administers the DTaP vaccine to a child younger than 7 years as part of their routine immunization schedule or when a catch-up immunization is needed. The code should be used for each dose of the vaccine administered.

6. Documentation requirements

To support a claim for CPT 90700, the following information should be documented:

• Date of service
• Patient’s age
• Vaccine product administered
• Administration route
• Purpose of the vaccine
• Provider’s signature

7. Billing guidelines

When billing for CPT code 90700, it is essential to follow specific guidelines and rules. These include reporting separate codes for vaccine administration, the actual vaccine, and an office visit based on the documentation. Some insurance companies may require appending modifier 25 to the associated evaluation and management (E/M) code. Additionally, Medicare and private insurance companies might have different guidelines for reporting vaccines or specific vaccines during the same visit. It is crucial to check with individual payers for their specific guidelines and have the policy in writing to protect your practice.

8. Historical information

CPT 90700 was added to the Current Procedural Terminology system on January 1, 1994. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2008.

9. Similar codes to CPT 90700

Five similar codes to CPT 90700 include:

• CPT 90696: A combination vaccine for diphtheria, tetanus toxoids, and acellular pertussis (DTaP) and inactivated poliovirus (IPV).
• CPT 90697: A combination vaccine for diphtheria, tetanus toxoids, acellular pertussis (DTaP), Haemophilus influenzae type b (Hib), and inactivated poliovirus (IPV).
• CPT 90698: A combination vaccine for diphtheria, tetanus toxoids, acellular pertussis (DTaP), Haemophilus influenzae type b (Hib), and hepatitis B (HepB).
• CPT 90701: A combination vaccine for diphtheria and tetanus toxoids and whole-cell pertussis (DTP).
• CPT 90702: A combination vaccine for diphtheria and tetanus toxoids (DT) for children younger than 7 years.

10. Examples

Here are 10 detailed examples of CPT code 90700 procedures:

1. A 2-month-old infant receives their first dose of the DTaP vaccine during a well-child visit.
2. A 4-month-old infant receives their second dose of the DTaP vaccine during a well-child visit.
3. A 6-month-old infant receives their third dose of the DTaP vaccine during a well-child visit.
4. A 15-month-old toddler receives their fourth dose of the DTaP vaccine during a well-child visit.
5. A 4-year-old child receives their fifth and final dose of the DTaP vaccine during a well-child visit.
6. A 3-year-old child who missed their fourth dose of the DTaP vaccine receives a catch-up immunization.
7. A 5-year-old child who missed their fifth dose of the DTaP vaccine receives a catch-up immunization.
8. A 6-year-old child who has not completed their DTaP vaccine series receives a catch-up immunization.
9. A 2-year-old child with a contraindication to a previous DTaP dose receives a catch-up immunization.
10. A 4-year-old child who has not received any DTaP vaccines due to a medical exemption receives their first dose of the vaccine.