How To Use CPT Code 90288

CPT 90288 refers to the administration of botulism immune globulin, human, for intravenous use. This therapeutic intervention is critical in the management of botulism, a severe illness caused by a neurotoxin produced by the bacterium Clostridium botulinum. The immune globulin is derived from pooled plasma of adults who have been immunized with pentavalent botulinum toxoid, providing passive immunity to patients at risk of or diagnosed with botulism. The intravenous administration allows for rapid distribution of the immune globulin throughout the body, offering immediate protection against the effects of the toxin.

1. What is CPT code 90288?

CPT code 90288 represents the administration of botulism immune globulin, a specialized treatment used to provide immediate passive immunity against botulism. Botulism is a life-threatening condition characterized by muscle paralysis due to the action of botulinum toxin. The immune globulin is formulated from the plasma of immunized donors, ensuring that it contains antibodies effective against the toxin. The purpose of this code is to facilitate the billing and documentation of this critical therapeutic service, which is essential in treating patients who have been exposed to or are suffering from botulism. The clinical relevance of this code lies in its role in preventing the progression of the disease and mitigating its potentially fatal effects.

2. Qualifying Circumstances

This CPT code can be utilized in specific clinical scenarios where a patient is diagnosed with botulism or is at high risk of developing the condition. The use of this code is appropriate when a healthcare provider administers botulism immune globulin intravenously to provide immediate protection against the neurotoxin. Limitations include the necessity for a confirmed diagnosis of botulism or a high suspicion of exposure to the toxin. It is inappropriate to use this code for patients who do not meet these criteria or for unrelated conditions. Additionally, the administration should be performed in a controlled medical setting where monitoring for adverse reactions can occur.

3. When To Use CPT 90288

CPT code 90288 is used when a healthcare provider administers botulism immune globulin intravenously to a patient. It is essential to document the patient’s diagnosis and the rationale for treatment to justify the use of this code. This code should be reported separately from other procedures or services provided during the same encounter, as it specifically pertains to the administration of the immune globulin. It is important to note that this code cannot be used in conjunction with codes for other immunoglobulin preparations unless specifically indicated, as each code represents distinct therapeutic interventions.

4. Official Description of CPT 90288

Official Descriptor: Botulism immune globulin, human, for intravenous use.

5. Clinical Application

The clinical application of CPT 90288 is primarily in the treatment of botulism, a serious illness that can lead to respiratory failure and death if not treated promptly. The administration of botulism immune globulin is crucial for patients who have been exposed to the botulinum toxin, as it provides immediate passive immunity. This treatment is particularly important in cases of foodborne botulism, infant botulism, and wound botulism, where timely intervention can significantly improve patient outcomes. The use of this code ensures that healthcare providers can effectively document and bill for this life-saving treatment.

5.1 Provider Responsibilities

During the procedure, the provider is responsible for several key actions. First, they must assess the patient to confirm the diagnosis of botulism or potential exposure to the toxin. Once confirmed, the provider prepares the botulism immune globulin for intravenous administration, ensuring that the appropriate dosage is calculated based on the patient’s weight and clinical condition. The provider then selects an appropriate intravenous site and uses a suitable needle to administer the immune globulin slowly into the patient’s vein. Throughout the infusion, the provider monitors the patient for any adverse reactions or complications, ensuring that the treatment is delivered safely and effectively.

5.2 Unique Challenges

One of the unique challenges associated with the administration of botulism immune globulin is the potential for allergic reactions or adverse effects during the infusion. Providers must be vigilant in monitoring the patient for signs of anaphylaxis or other complications. Additionally, the complexity of determining the appropriate timing and dosage of the immune globulin can pose challenges, particularly in cases where the patient’s clinical status may be rapidly changing. Ensuring that the treatment is administered in a timely manner is critical, as delays can lead to worsening of the patient’s condition.

5.3 Pre-Procedure Preparations

Before administering botulism immune globulin, the provider must conduct a thorough evaluation of the patient, including a detailed medical history and physical examination. Laboratory tests may be necessary to confirm the diagnosis of botulism and assess the patient’s overall health status. The provider should also review the patient’s medication history to identify any potential contraindications or interactions with the immune globulin. Proper preparation ensures that the provider is equipped to deliver the treatment safely and effectively.

5.4 Post-Procedure Considerations

After the administration of botulism immune globulin, the provider must continue to monitor the patient for any delayed reactions or complications. This includes observing vital signs and assessing the patient’s neurological status to ensure that the treatment is having the desired effect. Follow-up care may involve additional supportive measures, such as respiratory support or further medical interventions, depending on the severity of the botulism. Documentation of the procedure and the patient’s response is essential for ongoing care and treatment planning.

6. Relevant Terminology

Botulism: A serious illness caused by a neurotoxin produced by the bacteria Clostridium botulinum, leading to respiratory and muscular paralysis. It can occur through ingestion of contaminated food, intestinal infection in infants, wound infections, or inhalation.

Immunoglobulin: A complex protein produced by the immune system to protect the body from infections, providing passive immunity when administered from external sources.

CMV immunoglobulin: A preparation of human immunoglobulin specifically for intravenous administration, often used in patients with cytomegalovirus infections.

7. Clinical Examples

1. A 35-year-old man presents to the emergency department with symptoms of weakness and difficulty swallowing after consuming home-canned goods. The provider administers botulism immune globulin intravenously to prevent the progression of botulism.

2. An infant is diagnosed with infant botulism after presenting with constipation and poor feeding. The healthcare team administers botulism immune globulin to provide immediate protection against the neurotoxin.

3. A patient with a history of wound botulism from injecting drugs is treated in the hospital. The provider administers botulism immune globulin intravenously to mitigate the effects of the toxin.

4. A foodborne botulism outbreak is reported in a local community. Public health officials recommend administering botulism immune globulin to individuals who may have been exposed to contaminated food.

5. A 60-year-old woman with respiratory distress is suspected of having botulism after consuming improperly canned vegetables. The provider initiates treatment with botulism immune globulin to address the potential toxin exposure.

6. A healthcare provider encounters a patient with neurological symptoms consistent with botulism. After confirming the diagnosis, the provider administers botulism immune globulin intravenously as part of the treatment plan.

7. A child presents with signs of muscle weakness and is diagnosed with infant botulism. The pediatrician administers botulism immune globulin to provide immediate passive immunity.

8. A patient recovering from a botulism infection requires follow-up care. The healthcare team monitors the patient for any lingering effects and ensures that the immune globulin treatment was effective.

9. A woman with a history of foodborne botulism is educated on the importance of seeking immediate medical attention if she experiences symptoms after consuming canned foods. She is informed about the role of botulism immune globulin in her treatment.

10. A public health nurse conducts outreach in a community affected by a botulism outbreak, educating residents about the signs and symptoms of the illness and the importance of botulism immune globulin for those exposed.