How To Use CPT Code 90756

CPT 90756 refers to the administration of an antibiotic-free, quadrivalent influenza virus vaccine derived from cell cultures, with a 0.5 mL dosage 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 code 90756.

1. What is CPT 90756?

CPT 90756 is a medical billing code used to describe the administration of a specific type of influenza virus vaccine. This vaccine is quadrivalent, meaning it provides immunity against four different strains of the influenza virus. It is derived from cell cultures and is antibiotic-free, with a 0.5 mL dosage intended for intramuscular use. This code is used by medical professionals to bill for the administration of this vaccine to eligible patients.

2. 90756 CPT code description

The official description of CPT code 90756 is: “Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use.”

3. Procedure

1. The provider reviews the patient’s medical history and discusses the risks, benefits, and potential side effects of the vaccine with the patient, parent, or guardian.
2. The patient is appropriately prepped for the vaccine administration.
3. The provider injects 0.5 mL of the antibiotic-free, quadrivalent influenza vaccine into the muscle belly of the upper arm.
4. Post-vaccine care instructions and precautions are provided to the patient, parent, or guardian.

4. Qualifying circumstances

Patients eligible to receive CPT code 90756 services include those who are at risk for complications from the influenza virus, such as individuals with chronic health conditions, pregnant women, and elderly individuals. Additionally, healthcare workers and individuals in close contact with high-risk populations may also be eligible for this vaccine. It is essential to consult with a healthcare provider to determine if a patient qualifies for the administration of this specific vaccine.

5. When to use CPT code 90756

CPT code 90756 should be used when billing for the administration of the quadrivalent, cell-culture-derived, antibiotic-free influenza vaccine with a 0.5 mL dosage for intramuscular use. This code is appropriate when the vaccine is administered to eligible patients during the influenza season or as recommended by the healthcare provider.

6. Documentation requirements

Documentation supporting a claim for CPT 90756 should include the following information:

• Patient’s medical history and risk factors for influenza complications
• Discussion of risks, benefits, and potential side effects of the vaccine with the patient, parent, or guardian
• Details of the vaccine administration, including the injection site and dosage
• Post-vaccine care instructions and precautions provided to the patient, parent, or guardian

7. Billing guidelines

When billing for CPT code 90756, it is essential to follow the appropriate billing guidelines and rules. These may include reporting separate codes for the vaccine administration, the actual vaccine, and an office visit. Additionally, sufficient documentation from the provider explaining the product administered, administration route, and purpose should be included with the claim.

8. Historical information

CPT 90756 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to this code since its addition.

9. Similar codes to CPT 90756

Five similar codes to CPT 90756 and how they differ are:

1. CPT 90749: This code is used for unlisted vaccine or toxoid procedures, which do not have a specific CPT code assigned.
2. CPT 90686: This code refers to a quadrivalent influenza vaccine, but it is derived from a different production method and is not antibiotic-free.
3. CPT 90688: This code is for a trivalent influenza vaccine, which provides immunity against three strains of the influenza virus instead of four.
4. CPT 90715: This code is for the administration of a tetanus, diphtheria, and acellular pertussis vaccine, not an influenza vaccine.
5. CPT 90736: This code is for the administration of a zoster (shingles) vaccine, not an influenza vaccine.

10. Examples

Here are 10 detailed examples of CPT code 90756 procedures:

1. A 65-year-old patient with a history of chronic obstructive pulmonary disease (COPD) receives the quadrivalent, cell-culture-derived, antibiotic-free influenza vaccine.
2. A pregnant woman in her second trimester receives the CPT 90756 vaccine to protect against potential influenza complications during pregnancy.
3. A healthcare worker in a long-term care facility receives the CPT 90756 vaccine to reduce the risk of transmitting the influenza virus to vulnerable residents.
4. An adult with diabetes receives the CPT 90756 vaccine due to their increased risk of influenza complications.
5. A teacher who works with young children receives the CPT 90756 vaccine to protect against potential exposure to the influenza virus in the classroom.
6. A patient with a history of asthma receives the CPT 90756 vaccine to reduce the risk of influenza-related respiratory complications.
7. An individual with a compromised immune system due to an autoimmune disease receives the CPT 90756 vaccine for added protection against the influenza virus.
8. A patient with a history of heart disease receives the CPT 90756 vaccine to reduce the risk of influenza-related cardiac complications.
9. A caregiver for an elderly family member receives the CPT 90756 vaccine to protect against potential transmission of the influenza virus to their high-risk family member.
10. A patient with a history of kidney disease receives the CPT 90756 vaccine to reduce the risk of influenza-related renal complications.