How To Use CPT Code 90707

CPT 90707 refers to the measles, mumps, and rubella virus vaccine (MMR), a live combination vaccine administered subcutaneously to prevent these three infectious diseases. This vaccine is crucial in public health as it protects individuals, particularly children, from serious complications associated with measles, mumps, and rubella, which can lead to severe health issues and even death. The administration of this vaccine is a standard practice in pediatric care and is part of the recommended immunization schedule.

1. What is CPT code 90707?

CPT code 90707 represents the administration of the measles, mumps, and rubella (MMR) vaccine, which is a live attenuated vaccine designed to provide immunity against these three viral infections. The MMR vaccine is typically given to children as part of their routine immunizations, starting at 12 to 15 months of age, with a second dose administered before they enter kindergarten. The vaccine works by introducing a modified form of the viruses into the body, prompting an immune response that prepares the immune system to fight off these infections in the future. The clinical relevance of this vaccine cannot be overstated, as it has significantly reduced the incidence of these diseases in populations where vaccination rates are high.

2. Qualifying Circumstances

This CPT code can be used under specific circumstances, primarily when administering the MMR vaccine to eligible patients. The vaccine is appropriate for children aged 12 months and older, as well as for individuals born after 1956 who are unsure of their immunization status or have received only one dose prior to school entry. However, it is important to note that the MMR vaccine should not be administered to pregnant women or those planning to become pregnant within one to three months due to the risk of serious birth defects. Additionally, providers must verify that women of childbearing age are immune to rubella before pregnancy to prevent potential complications.

3. When To Use CPT 90707

CPT code 90707 is used when a healthcare provider administers the MMR vaccine subcutaneously, typically in the arm or leg. It is essential to document the administration details, including the product used, the route of administration, and the purpose of the vaccine. This code should be reported separately from the administration of the vaccine and any associated office visit codes. Providers should be aware that some insurance companies may require the use of modifier 25 to indicate that a significant, separately identifiable evaluation and management service was performed on the same day as the vaccine administration. Additionally, different payers may have varying guidelines regarding the reporting of vaccines, so it is crucial to check with individual insurance providers for their specific requirements.

4. Official Description of CPT 90707

Official Descriptor: Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous use.

5. Clinical Application

The clinical application of CPT code 90707 is centered around the prevention of measles, mumps, and rubella through vaccination. The MMR vaccine is vital in controlling outbreaks of these diseases, which can have severe health consequences, particularly in young children. The vaccine not only protects the individual receiving it but also contributes to herd immunity, reducing the overall prevalence of these infections in the community. This is particularly important for those who cannot be vaccinated due to medical reasons, as it helps protect vulnerable populations.

5.1 Provider Responsibilities

During the administration of the MMR vaccine, the provider has several responsibilities. First, they must present the parent, guardian, or patient with information regarding the vaccine, including its benefits, risks, and potential side effects. After ensuring that the patient is appropriately prepared and has consented to the vaccination, the provider administers the vaccine subcutaneously. It is also the provider’s responsibility to verify the immunization status of women of childbearing age to ensure they are immune to rubella before pregnancy.

5.2 Unique Challenges

One of the unique challenges associated with the administration of the MMR vaccine is addressing vaccine hesitancy among parents or guardians. Concerns about vaccine safety and potential side effects can lead to reluctance in immunizing children. Providers must be equipped to provide accurate information and reassurance to alleviate these concerns. Additionally, ensuring that the vaccine is administered at the appropriate age and that patients receive the required two doses can be challenging, particularly in populations with lower healthcare access.

5.3 Pre-Procedure Preparations

Before administering the MMR vaccine, providers must conduct a thorough evaluation of the patient’s medical history, including any previous vaccinations and potential contraindications. This includes assessing the patient’s age, health status, and any history of allergic reactions to vaccine components. Providers should also ensure that the vaccine is stored correctly and is within its expiration date prior to administration.

5.4 Post-Procedure Considerations

After administering the MMR vaccine, providers should monitor the patient for any immediate adverse reactions, such as allergic responses. Patients should be informed about potential side effects, which may include mild fever or rash, and advised on when to seek medical attention if they experience severe reactions. Follow-up appointments should be scheduled to ensure that the second dose of the vaccine is administered at the appropriate time, typically before the child starts kindergarten.

6. Relevant Terminology

Antigen: A substance that induces an immune response, often a foreign body like bacteria or viruses.

Combination vaccine: A vaccine that protects against multiple diseases, reducing the number of injections needed.

Immune: The state of being protected against infection.

Immunization: The process of administering a vaccine to provide protection against infectious diseases.

Infectious: Capable of causing infection or disease.

Live virus vaccine: A vaccine made from a weakened form of the virus that can still provoke an immune response without causing disease.

Measles: A highly contagious viral infection characterized by fever and a distinctive rash.

Mumps: A viral infection that primarily causes swelling of the parotid glands.

Rubella: Also known as German measles, it can cause serious birth defects if contracted during pregnancy.

Subcutaneous: Referring to the layer of tissue beneath the skin where the vaccine is administered.

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

Virus: A microscopic infectious agent that requires a living host to replicate.

7. Clinical Examples

1. A 15-month-old child receives their first dose of the MMR vaccine during a routine pediatric visit.

2. A 5-year-old child is administered the second dose of the MMR vaccine before starting kindergarten.

3. An adult born in 1960 who is unsure of their immunization status receives the MMR vaccine after consultation with their healthcare provider.

4. A healthcare provider discusses the benefits and risks of the MMR vaccine with a parent who is hesitant about vaccinations.

5. A pregnant woman is advised against receiving the MMR vaccine due to the potential risks to her unborn child.

6. A child experiences a mild fever and rash after receiving the MMR vaccine, which is documented as a common side effect.

7. A healthcare provider verifies that a woman of childbearing age has immunity to rubella before administering the MMR vaccine.

8. A clinic schedules follow-up appointments for children to ensure they receive their second dose of the MMR vaccine on time.

9. A healthcare provider checks the storage conditions of the MMR vaccine to ensure it is administered safely.

10. A parent is informed about the importance of the MMR vaccine in preventing outbreaks of measles, mumps, and rubella in the community.