How To Use CPT Code 90670
CPT 90670 refers to the administration of the pneumococcal conjugate vaccine, 13 valent (PCV13), 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 90670 procedures.
1. What is CPT 90670?
CPT 90670 is a medical code used to describe the administration of the pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use. This vaccine is designed to protect infants and young children against 13 specific strains of pneumococcus, a bacterial organism that causes various infectious diseases such as ear infections, pneumonia, and meningitis.
2. 90670 CPT code description
The official description of CPT code 90670 is: “Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use.”
The 90670 procedure involves the following steps:
- The patient is appropriately prepped for the vaccine administration.
- The provider counsels the patient’s family and provides instructions and precautions before administering the vaccine.
- The provider injects the PCV13 vaccine into the patient’s muscle, usually as part of a series of four injections.
- After the injection, the provider monitors the patient for any adverse reactions or side effects.
- The provider documents the vaccine administration in the patient’s medical record.
4. Qualifying circumstances
CPT code 90670 services are eligible for infants and young children who are at risk of contracting pneumococcal infections. The vaccine is typically administered as part of a series of four injections, given at 2, 4, 6, and 12-15 months of age. In some cases, older children and adults with certain medical conditions may also be eligible to receive the PCV13 vaccine.
5. When to use CPT code 90670
It is appropriate to bill the 90670 CPT code when a provider administers the PCV13 vaccine to an eligible patient. This includes infants and young children who are at risk of contracting pneumococcal infections, as well as older children and adults with specific medical conditions that warrant the administration of the vaccine.
6. Documentation requirements
To support a claim for CPT 90670, the following information needs to be documented:
- Patient’s age and medical history, including any risk factors for pneumococcal infections.
- Date and time of the vaccine administration.
- Specific vaccine product administered (PCV13).
- Administration route (intramuscular).
- Dosage and injection site.
- Provider’s counseling and instructions given to the patient’s family.
- Any observed adverse reactions or side effects.
7. Billing guidelines
When billing for CPT code 90670, it is essential to follow the appropriate guidelines and rules. These include:
- Reporting separate codes for vaccine administration, the actual vaccine, and an office visit.
- Ensuring sufficient documentation from the provider, explaining the product administered, administration route, and purpose.
- Verifying the patient’s eligibility for the vaccine based on age and medical conditions.
- Checking for any payer-specific requirements or guidelines related to vaccine billing.
8. Historical information
CPT 90670 was added to the Current Procedural Terminology system on January 1, 2010. The code was updated on January 1, 2016, with a change in the descriptor from “Pneumococcal conjugate vaccine, 13 valent, for intramuscular use” to “Pneumococcal conjugate vaccine, 13 valent (PCV13), for intramuscular use.”
9. Similar codes to CPT 90670
Five similar codes to CPT 90670 and how they differentiate are:
- CPT 90669: This code is for the administration of the pneumococcal conjugate vaccine, 7 valent (PCV7), which protects against seven strains of pneumococcus.
- CPT 90672: This code is for the administration of the quadrivalent live intranasal influenza vaccine.
- CPT 90732: This code is for the administration of the pneumococcal polysaccharide vaccine (PPSV23), which protects against 23 strains of pneumococcus and is typically given to adults.
- CPT 90715: This code is for the administration of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine.
- CPT 90716: This code is for the administration of the varicella (chickenpox) vaccine.
Here are 10 detailed examples of CPT code 90670 procedures:
- A 2-month-old infant receives their first dose of the PCV13 vaccine as part of their routine immunization schedule.
- A 4-month-old infant receives their second dose of the PCV13 vaccine during a well-child visit.
- A 6-month-old infant receives their third dose of the PCV13 vaccine at a pediatric clinic.
- A 12-month-old child receives their fourth and final dose of the PCV13 vaccine during a routine check-up.
- A 3-year-old child with a history of recurrent ear infections receives the PCV13 vaccine to reduce the risk of future infections.
- A 5-year-old child with a compromised immune system receives the PCV13 vaccine for added protection against pneumococcal infections.
- An 8-year-old child with a cochlear implant receives the PCV13 vaccine due to an increased risk of pneumococcal meningitis.
- A 15-year-old adolescent with a chronic lung condition receives the PCV13 vaccine for added protection against pneumonia.
- A 25-year-old adult with a history of recurrent pneumococcal infections receives the PCV13 vaccine as part of their ongoing medical care.
- A 45-year-old adult with a compromised immune system due to an organ transplant receives the PCV13 vaccine for added protection against pneumococcal infections.