How To Use CPT Code 90670

CPT 90670 refers to the pneumococcal conjugate vaccine, 13 valent (PCV13), which is administered intramuscularly. This vaccine is crucial in protecting infants and young children against 13 specific strains of pneumococcus, a bacterium responsible for various serious infections, including ear infections, pneumonia, and meningitis. The administration of this vaccine is typically part of a series of immunizations aimed at building a strong defense against these potentially life-threatening diseases.

1. What is CPT code 90670?

CPT code 90670 represents the pneumococcal conjugate vaccine, specifically the 13 valent formulation (PCV13). This vaccine is designed to provide immunity against 13 different serotypes of Streptococcus pneumoniae, the bacterium that causes a range of infections, particularly in young children. The primary purpose of this vaccine is to prevent pneumococcal diseases, which can lead to severe health complications such as pneumonia, meningitis, and otitis media (ear infections). The clinical relevance of this vaccine is significant, as pneumococcal infections can be particularly dangerous for infants and young children, who are more susceptible to these diseases due to their developing immune systems. The vaccine is typically administered as part of a routine immunization schedule, ensuring that children receive adequate protection during their early years.

2. Qualifying Circumstances

The use of CPT code 90670 is specifically qualified for administration to infants and young children, typically starting from two months of age. The vaccine is administered intramuscularly, usually in a series of four doses, with specific intervals between each dose as recommended by health authorities. It is important to note that this vaccine should not be administered to individuals who have a known allergy to any component of the vaccine or those who are currently experiencing moderate to severe illness. Additionally, proper documentation must be maintained to justify the administration of the vaccine, including details about the patient’s age, health status, and any previous vaccinations received.

3. When To Use CPT 90670

CPT code 90670 is used when administering the PCV13 vaccine to eligible pediatric patients. It is essential to follow the recommended immunization schedule, which typically includes doses at 2, 4, 6, and 12-15 months of age. When coding for immunizations, it is crucial to report separate codes for the vaccine administration, the vaccine itself, and any associated office visit. This ensures accurate billing and documentation. It is also important to note that this code should not be used in conjunction with codes for other pneumococcal vaccines, such as the 23 valent pneumococcal polysaccharide vaccine (PPSV23), as they serve different purposes and target different age groups.

4. Official Description of CPT 90670

Official Descriptor: Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use.

5. Clinical Application

The clinical application of CPT code 90670 is primarily focused on the prevention of pneumococcal diseases in infants and young children. The administration of the PCV13 vaccine is a critical component of pediatric healthcare, as it significantly reduces the incidence of serious infections caused by pneumococcus. By immunizing children against these specific strains, healthcare providers can help prevent hospitalizations and complications associated with pneumococcal infections, thereby improving overall child health outcomes. The vaccine is particularly important in communities where pneumococcal disease is prevalent, and it plays a vital role in public health initiatives aimed at reducing the burden of infectious diseases in the pediatric population.

5.1 Provider Responsibilities

During the administration of the PCV13 vaccine, the provider has several key responsibilities. First, they must ensure that the patient is appropriately prepped for the vaccination, which includes verifying the patient’s age and health status. The provider then prepares the vaccine for intramuscular injection, typically in the thigh muscle for infants and young children. After administering the vaccine, the provider must counsel the patient’s family, providing them with information about the vaccine, its benefits, and any potential side effects. Additionally, the provider should offer instructions on post-vaccination care and what to monitor for in the days following the administration.

5.2 Unique Challenges

One of the unique challenges associated with the administration of the PCV13 vaccine is ensuring that the patient is calm and cooperative, especially in young children who may be fearful of needles. Providers must be skilled in pediatric communication techniques to help alleviate anxiety and ensure a smooth vaccination process. Additionally, there may be logistical challenges in maintaining proper storage conditions for the vaccine, as it must be kept at specific temperatures to remain effective. Providers must also navigate parental concerns or misconceptions about vaccines, requiring them to be well-informed and prepared to address questions and provide reassurance.

5.3 Pre-Procedure Preparations

Before administering the PCV13 vaccine, providers must conduct a thorough evaluation of the patient’s medical history, including any previous vaccinations and potential allergies. It is essential to confirm that the patient is within the appropriate age range for the vaccine and that they are not currently experiencing any acute illnesses that could contraindicate vaccination. Providers should also prepare the necessary documentation to record the administration details, including the vaccine lot number, expiration date, and the site of injection.

5.4 Post-Procedure Considerations

After the administration of the PCV13 vaccine, providers should monitor the patient for any immediate adverse reactions, such as allergic responses or excessive swelling at the injection site. Families should be given clear instructions on what to expect following the vaccination, including common side effects like mild fever or irritability. Follow-up appointments may be scheduled to ensure that the patient receives the complete series of vaccinations as recommended. Providers should also encourage families to report any unusual reactions or concerns that arise after the vaccination.

6. Relevant Terminology

Immunization: The process of making a person immune to an infectious disease, typically through vaccination with a modified form of the pathogen.

Intramuscular: Refers to the administration of a substance directly into the muscle tissue, allowing for rapid absorption into the bloodstream.

Pneumococcal conjugate vaccine, 13 valent (PCV13): A vaccine that protects against 13 specific strains of pneumococcus, a bacterium responsible for serious infections.

Pneumococcus: The common name for Streptococcus pneumoniae, a bacterium that can cause various infections, including pneumonia and meningitis.

Pneumonia: An infection that causes inflammation in the lungs, leading to symptoms such as cough, fever, and difficulty breathing.

Vaccine: A biological preparation that provides active acquired immunity to a particular infectious disease by introducing a harmless form of the pathogen.

7. Clinical Examples

1. A two-month-old infant receives their first dose of the PCV13 vaccine during a well-child visit.

2. A healthcare provider administers the PCV13 vaccine to a child who is four months old, ensuring that the child is healthy and has no contraindications.

3. A parent expresses concerns about vaccine side effects; the provider reassures them and explains the importance of the PCV13 vaccine in preventing serious infections.

4. A child who is six months old receives their second dose of the PCV13 vaccine as part of their routine immunization schedule.

5. A provider documents the administration of the PCV13 vaccine, including the lot number and expiration date, in the child’s medical record.

6. A toddler receives their final dose of the PCV13 vaccine at 15 months of age, completing the vaccination series.

7. A healthcare provider discusses the importance of the PCV13 vaccine with a family during a routine check-up, highlighting its role in preventing pneumonia and meningitis.

8. A child experiences mild fever after receiving the PCV13 vaccine; the provider advises the family on how to manage the symptoms.

9. A provider reviews the vaccination history of a three-year-old child to ensure they have received all recommended doses of the PCV13 vaccine.

10. A healthcare facility implements a reminder system to notify parents when their children are due for the PCV13 vaccine, ensuring timely immunization.