How To Use CPT Code 90656

CPT 90656 describes the administration of a preservative-free, trivalent influenza virus vaccine, in 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 billing examples.

1. What is CPT Code 90656?

CPT 90656 is used to report the administration of a preservative-free, trivalent influenza virus vaccine. This vaccine is given in a 0.5 mL dosage and is administered via intramuscular injection. It provides immunity against three different strains of the influenza virus, which is a severe and infectious respiratory disease.

2. Official Description

The official description of CPT code 90656 is: ‘Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use.’

3. Procedure

1. The healthcare provider presents the options for immunization to the patient or their guardian, explaining the risks, benefits, potential side effects, and providing instructions and precautions.
2. The provider administers a 0.5 mL dosage of the preservative-free, trivalent influenza virus vaccine via intramuscular injection.
3. The vaccine contains an altered form of the influenza virus, which triggers an immune response in the body and provides protection against three different strains of the virus.
4. The injection is typically given in the muscle of the upper arm or thigh.
5. The patient may experience mild side effects such as soreness at the injection site, low-grade fever, or muscle aches, which usually resolve within a few days.
6. Additional doses of the vaccine may be required depending on the patient’s age, health condition, and previous immunization history.

4. Qualifying circumstances

CPT 90656 is used for patients who require immunization against the influenza virus. It is suitable for individuals aged 3 years and older. The vaccine is preservative-free and is administered via intramuscular injection. The patient may be at risk of contracting the influenza virus or may need protection due to their age, health condition, or other factors determined by the healthcare provider.

5. When to use CPT code 90656

CPT code 90656 should be used when a healthcare provider administers the preservative-free, trivalent influenza virus vaccine in a 0.5 mL dosage via intramuscular injection. It is appropriate for patients aged 3 years and older who require immunization against the influenza virus. This code should be reported for each individual patient who receives the vaccine.

6. Documentation requirements

To support a claim for CPT 90656, the healthcare provider must document the following information:

• Administration of the preservative-free, trivalent influenza virus vaccine
• Date of administration
• Dosage administered (0.5 mL)
• Route of administration (intramuscular)
• Any relevant patient information, such as age or health condition
• Signature of the healthcare provider administering the vaccine

7. Billing guidelines

When billing for CPT 90656, ensure that the vaccine administered is the preservative-free, trivalent influenza virus vaccine in a 0.5 mL dosage. The administration should be documented as intramuscular. It is important to follow the specific guidelines provided by the payer regarding the appropriate use of this code and any additional documentation requirements.

8. Historical information

CPT 90656 was added to the Current Procedural Terminology system on January 1, 2005. There have been several updates to the code since its addition, including changes to the description and qualifying circumstances. The most recent update was on January 1, 2017.

9. Examples

1. A healthcare provider administers the preservative-free, trivalent influenza virus vaccine to a 5-year-old child via intramuscular injection.
2. A nurse administers the preservative-free, trivalent influenza virus vaccine to an elderly patient in a nursing home.
3. A pediatrician administers the preservative-free, trivalent influenza virus vaccine to a 2-year-old toddler during a routine check-up.
4. A pharmacist administers the preservative-free, trivalent influenza virus vaccine to a pregnant woman at a community health clinic.
5. A healthcare provider administers the preservative-free, trivalent influenza virus vaccine to a patient with a chronic respiratory condition.
6. A school nurse administers the preservative-free, trivalent influenza virus vaccine to a group of students during a vaccination campaign.
7. A healthcare provider administers the preservative-free, trivalent influenza virus vaccine to a patient with a weakened immune system.
8. A physician administers the preservative-free, trivalent influenza virus vaccine to a patient with a history of severe allergic reactions.
9. A healthcare provider administers the preservative-free, trivalent influenza virus vaccine to a patient before they travel to a region with a high incidence of influenza.
10. A nurse administers the preservative-free, trivalent influenza virus vaccine to a patient in a hospital setting to prevent the spread of influenza.