How To Use CPT Code 90677

CPT 90677 refers to the pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90677.

1. What is CPT 90677?

CPT 90677 is a code used to represent the pneumococcal conjugate vaccine, 20 valent (PCV20), which is administered intramuscularly. This vaccine is designed to protect against pneumococcal disease, a bacterial infection that can cause various illnesses ranging from ear infections to pneumonia and bloodstream infections. The code is specific to the 20-valent pneumococcal conjugate vaccine, meaning it covers 20 different types of pneumococcal bacteria. The administration of the vaccine is reported separately.

2. 90677 CPT code description

The official description of CPT code 90677 is: “Pneumococcal conjugate vaccine, 20 valent (PCV20), for intramuscular use.”

3. Procedure

The 90677 procedure involves the following steps:

1. Assess the patient’s medical history and determine eligibility for the PCV20 vaccine.
2. Obtain informed consent from the patient or their guardian.
3. Prepare the vaccine by following the manufacturer’s instructions.
4. Select an appropriate injection site, typically the deltoid muscle of the upper arm or the anterolateral thigh in infants and young children.
5. Clean the injection site with an alcohol swab and allow it to dry.
6. Administer the vaccine intramuscularly using a sterile needle and syringe.
7. Dispose of the used needle and syringe in a sharps container.
8. Document the vaccine administration in the patient’s medical record, including the date, vaccine type, lot number, and injection site.
9. Provide the patient with a vaccination record and information on potential side effects.
10. Monitor the patient for any immediate adverse reactions.

4. Qualifying circumstances

Eligibility for CPT code 90677 services depends on the patient’s age, medical history, and risk factors for pneumococcal disease. The Centers for Disease Control and Prevention (CDC) recommends the PCV20 vaccine for:

• Adults aged 65 years and older
• Adults aged 19-64 years with certain medical conditions, such as chronic heart, lung, or liver disease, diabetes, or alcoholism
• Adults aged 19-64 years with weakened immune systems due to HIV, cancer, or other causes
• Adults aged 19-64 years who smoke cigarettes
• Children aged 2-18 years with certain medical conditions or risk factors

Healthcare providers should consult the most current CDC guidelines and recommendations for pneumococcal vaccination to determine eligibility for CPT code 90677 services.

5. When to use CPT code 90677

It is appropriate to bill CPT code 90677 when a healthcare provider administers the PCV20 vaccine to an eligible patient, as per the CDC guidelines and recommendations. The code should be used to represent the vaccine product, while a separate code should be reported for the vaccine administration.

6. Documentation requirements

To support a claim for CPT 90677, healthcare providers must document the following information in the patient’s medical record:

• Patient’s age, medical history, and risk factors for pneumococcal disease
• Eligibility for the PCV20 vaccine based on CDC guidelines and recommendations
• Informed consent obtained from the patient or their guardian
• Date of vaccine administration
• Vaccine type (PCV20)
• Vaccine lot number
• Injection site
• Any adverse reactions observed

7. Billing guidelines

When billing for CPT code 90677, healthcare providers should follow these guidelines:

• Report CPT 90677 for the vaccine product only. Use a separate code for the vaccine administration.
• Ensure that the patient’s medical record contains the required documentation to support the claim.
• Verify the patient’s insurance coverage for the PCV20 vaccine and administration.
• Check for any payer-specific billing requirements or guidelines.

8. Historical information

CPT 90677 was added to the Current Procedural Terminology system on July 1, 2021. There have been no updates since its addition.

9. Similar codes to CPT 90677

Five similar codes to CPT 90677 and how they differ are:

1. CPT 90670: Represents the 13-valent pneumococcal conjugate vaccine (PCV13) for intramuscular use, covering 13 types of pneumococcal bacteria.
2. CPT 90732: Represents the pneumococcal polysaccharide vaccine (PPSV23) for subcutaneous or intramuscular use, covering 23 types of pneumococcal bacteria.
3. CPT 90460: Represents the first component of a vaccine or toxoid administered to a patient through 18 years of age via any route of administration, with counseling by a physician or other qualified healthcare professional.
4. CPT 90461: Represents each additional vaccine or toxoid component administered to a patient through 18 years of age, with counseling by a physician or other qualified healthcare professional.
5. CPT 90471: Represents the first vaccine or toxoid administered to a patient through any route of administration, without counseling by a physician or other qualified healthcare professional.

10. Examples

Here are 10 detailed examples of CPT code 90677 procedures:

1. A 65-year-old patient with no prior pneumococcal vaccination receives the PCV20 vaccine during a routine visit to their primary care physician.
2. A 45-year-old patient with chronic heart disease and diabetes receives the PCV20 vaccine as part of their preventive care plan.
3. A 50-year-old patient with a weakened immune system due to cancer treatment receives the PCV20 vaccine to reduce their risk of pneumococcal infections.
4. A 60-year-old patient who smokes cigarettes receives the PCV20 vaccine during a visit to a community health clinic.
5. A 70-year-old patient with a history of pneumonia receives the PCV20 vaccine at a pharmacy immunization clinic.
6. A 55-year-old patient with chronic liver disease and alcoholism receives the PCV20 vaccine during a hospital stay for an unrelated condition.
7. A 40-year-old patient with HIV receives the PCV20 vaccine as part of their ongoing care at an infectious disease clinic.
8. A 30-year-old patient with a cochlear implant receives the PCV20 vaccine due to their increased risk of pneumococcal meningitis.
9. A 15-year-old patient with sickle cell disease receives the PCV20 vaccine during a routine checkup with their pediatrician.
10. A 10-year-old patient with a history of recurrent ear infections receives the PCV20 vaccine at a school-based immunization program.