How To Use CPT Code 90691

CPT 90691 refers to the administration of the typhoid vaccine, specifically the Vi capsular polysaccharide (ViCPs), which is delivered intramuscularly. This vaccine is crucial for preventing typhoid fever, a serious infectious disease caused by the bacterium Salmonella typhi. The vaccine is typically administered to individuals who are at risk of exposure, such as travelers to endemic areas. The procedure involves careful preparation and administration by a healthcare provider, ensuring that the patient is informed about the vaccine’s benefits and potential side effects.

1. What is CPT code 90691?

CPT code 90691 represents the administration of the Vi capsular polysaccharide vaccine, which is specifically designed to prevent typhoid fever. This vaccine is derived from the polysaccharide capsule of the Salmonella typhi bacterium, which is responsible for causing typhoid fever. The purpose of this vaccine is to stimulate the immune system to recognize and fight off the bacteria if the individual is exposed in the future. The clinical relevance of this vaccine is significant, particularly for individuals traveling to areas where typhoid fever is prevalent, as it provides a critical line of defense against this potentially life-threatening disease.

2. Qualifying Circumstances

This CPT code can be used when a patient is being immunized against typhoid fever through the administration of the ViCPs vaccine. It is appropriate in scenarios where the patient is at risk of exposure to Salmonella typhi, such as traveling to endemic regions or working in environments where the disease is common. Limitations include situations where the patient has a known allergy to any component of the vaccine or is experiencing acute illness. The use of this code is inappropriate if the vaccine is not administered according to the recommended guidelines, such as failing to complete the immunization at least two weeks prior to potential exposure.

3. When To Use CPT 90691

CPT code 90691 is used when a healthcare provider administers the Vi capsular polysaccharide vaccine intramuscularly. It is essential to document the administration route, the specific vaccine given, and the purpose of the immunization. This code should be reported separately from the vaccine administration code and any associated evaluation and management (E/M) codes. It is important to note that some insurance companies may require the use of modifier 25 to indicate that a significant, separately identifiable E/M service was performed on the same day as the vaccine administration. Additionally, providers should be aware of varying guidelines from Medicare and private insurers regarding the reporting of vaccines, especially when multiple vaccines are administered during the same visit.

4. Official Description of CPT 90691

Official Descriptor: Typhoid vaccine, Vi capsular polysaccharide (ViCPs), for intramuscular use.

5. Clinical Application

The clinical context for CPT 90691 involves the prevention of typhoid fever through vaccination. This vaccine is particularly important for individuals who may be exposed to contaminated food or water, as typhoid fever can lead to severe gastrointestinal illness and systemic infection. The administration of this vaccine is a proactive measure to protect public health, especially in areas where sanitation may be compromised. The importance of this service lies in its ability to reduce the incidence of typhoid fever, thereby preventing outbreaks and protecting vulnerable populations.

5.1 Provider Responsibilities

The provider’s responsibilities during the administration of the ViCPs vaccine include presenting the immunization options to the patient or their guardian, discussing the risks and benefits of the vaccine, and reviewing potential side effects. Once the patient is adequately informed and consent is obtained, the provider prepares the vaccine for injection. The vaccine is then administered intramuscularly, typically into the deltoid muscle for adults or the outer thigh muscle for children. The provider must ensure that the immunization is completed at least two weeks prior to any potential exposure to ensure adequate immune response.

5.2 Unique Challenges

Unique challenges associated with the administration of the ViCPs vaccine include managing patient anxiety regarding vaccinations, addressing concerns about potential side effects, and ensuring proper storage and handling of the vaccine to maintain its efficacy. Additionally, providers must navigate varying insurance guidelines and documentation requirements, which can complicate the billing process. Ensuring that patients receive the vaccine in a timely manner, especially before travel, can also pose logistical challenges.

5.3 Pre-Procedure Preparations

Before administering the ViCPs vaccine, the provider must conduct a thorough evaluation of the patient’s medical history, including any allergies, previous reactions to vaccines, and current health status. It is essential to confirm that the patient is not experiencing any acute illness that could contraindicate vaccination. The provider should also prepare the vaccine according to the manufacturer’s guidelines, ensuring that it is stored at the correct temperature and is within its expiration date.

5.4 Post-Procedure Considerations

After the administration of the ViCPs vaccine, the provider should monitor the patient for any immediate adverse reactions, such as allergic responses or injection site reactions. Patients should be informed about potential side effects and advised on what to expect in the days following vaccination. Follow-up care may include scheduling additional vaccinations if needed and providing educational materials about typhoid fever prevention, including safe food and water practices.

6. Relevant Terminology

Deltoid: The fan-shaped muscle located in the shoulder region, commonly used for intramuscular injections.

Immunization: The process of administering a modified form of an infectious agent to stimulate the immune system and provide protection against infectious diseases.

Immunize: To give a vaccine to an individual to induce immunity against a specific disease.

Infectious: Capable of causing infection in a host organism.

Intradermal: Referring to an injection administered within the skin layer.

Intramuscular: Referring to an injection administered directly into a muscle.

Salmonella typhi: The bacterium that causes typhoid fever, typically transmitted through contaminated food and water.

Subcutaneous: Referring to an injection administered beneath the skin.

Typhoid fever: A serious infectious disease characterized by high fever, abdominal pain, and gastrointestinal symptoms, acquired through ingestion of contaminated food or water.

Typhoid Vi capsular polysaccharide or ViCPs: A specific type of typhoid vaccine derived from the polysaccharide capsule of the Salmonella typhi bacterium.

Vaccine: A biological preparation that provides active acquired immunity to a particular infectious disease.

7. Clinical Examples

1. A traveler plans a trip to India and receives the ViCPs vaccine two weeks prior to departure to ensure protection against typhoid fever.

2. A healthcare provider discusses the benefits and risks of the typhoid vaccine with a parent whose child is traveling to a region where typhoid fever is endemic.

3. An adult patient with a history of gastrointestinal issues is advised to receive the ViCPs vaccine before working in a humanitarian aid project in a developing country.

4. A nurse administers the ViCPs vaccine to a patient in a clinic, ensuring that the injection is given in the deltoid muscle for optimal absorption.

5. A patient experiences mild soreness at the injection site after receiving the ViCPs vaccine but is reassured that this is a common side effect.

6. A healthcare provider documents the administration of the ViCPs vaccine in the patient’s medical record, including the date, dosage, and route of administration.

7. A public health campaign encourages local residents to get vaccinated against typhoid fever, highlighting the importance of immunization in preventing outbreaks.

8. A patient who received the ViCPs vaccine is educated on safe food and water practices to further reduce the risk of typhoid fever.

9. A clinic offers the ViCPs vaccine as part of a travel health package for individuals planning international trips.

10. A healthcare provider follows up with a patient who received the ViCPs vaccine to assess any side effects and reinforce the importance of vaccination.