How To Use CPT Code 90686

CPT 90686 describes the administration of a preservative-free, quadrivalent influenza virus vaccine, in a 0.5 mL dose, 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 90686?

CPT 90686 is used to describe the administration of a preservative-free, quadrivalent influenza virus vaccine. This vaccine is given in a 0.5 mL dose and is injected into the muscle of the patient. The purpose of this vaccine is to provide immunity against four different strains of the influenza virus, which is a severe and infectious respiratory disease.

2. Official Description

The official description of CPT code 90686 is: ‘Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, 0.5 mL dosage, for intramuscular use.’

3. Procedure

1. The healthcare provider prepares the patient for the administration of the influenza vaccine.
2. The provider selects the preservative-free, quadrivalent influenza virus vaccine in a 0.5 mL dose.
3. The provider administers the vaccine by injecting it into the muscle of the patient.
4. The patient may experience some discomfort or soreness at the injection site.
5. The provider provides instructions and precautions to the patient and/or their parent or guardian regarding the vaccine.
6. The provider may document the administration of the vaccine in the patient’s medical record.

4. Qualifying circumstances

CPT 90686 is used for patients who require immunization against the influenza virus. This vaccine is suitable for individuals aged 3 years and older. The vaccine is administered by a healthcare provider into the muscle of the patient. It is important to note that the vaccine is preservative-free and is designed to provide immunity against four different strains of the influenza virus.

5. When to use CPT code 90686

CPT code 90686 should be used when a healthcare provider administers the preservative-free, quadrivalent influenza virus vaccine in a 0.5 mL dose to a patient. This code is appropriate for patients aged 3 years and older who require immunization against the influenza virus. It is important to ensure that the vaccine is administered into the muscle of the patient.

6. Documentation requirements

To support a claim for CPT 90686, the healthcare provider must document the following information:

• The administration of the preservative-free, quadrivalent influenza virus vaccine
• The dosage of the vaccine (0.5 mL)
• The route of administration (intramuscular)
• The date of administration
• Any relevant patient information, such as age or medical history
• Any instructions or precautions provided to the patient or their parent/guardian
• Signature of the healthcare provider administering the vaccine

7. Billing guidelines

When billing for CPT 90686, ensure that the healthcare provider administers the preservative-free, quadrivalent influenza virus vaccine in a 0.5 mL dose. It is important to follow the specific guidelines provided by the payer regarding the documentation and coding requirements for this vaccine. Additionally, consider reporting separate codes for vaccine administration, the actual vaccine, and any associated office visits, if applicable.

8. Historical information

CPT 90686 was added to the Current Procedural Terminology system on January 1, 2014. Since then, there have been a few changes to the code, including updates to the official description and qualifying circumstances. It is important to stay updated with any changes or revisions to ensure accurate coding and billing.

9. Examples

1. A healthcare provider administers the preservative-free, quadrivalent influenza virus vaccine to a 5-year-old child.
2. A nurse administers the preservative-free, quadrivalent influenza virus vaccine to an adult patient.
3. A physician administers the preservative-free, quadrivalent influenza virus vaccine to a pregnant woman.
4. A healthcare provider administers the preservative-free, quadrivalent influenza virus vaccine to a patient with a compromised immune system.
5. A pharmacist administers the preservative-free, quadrivalent influenza virus vaccine to a patient at a community clinic.
6. A healthcare provider administers the preservative-free, quadrivalent influenza virus vaccine to a patient during a routine office visit.
7. A nurse administers the preservative-free, quadrivalent influenza virus vaccine to a patient at a long-term care facility.
8. A healthcare provider administers the preservative-free, quadrivalent influenza virus vaccine to a patient at a workplace vaccination clinic.
9. A pharmacist administers the preservative-free, quadrivalent influenza virus vaccine to a patient at a retail pharmacy.
10. A healthcare provider administers the preservative-free, quadrivalent influenza virus vaccine to a patient at a school-based immunization clinic.