How To Use CPT Code 90732

CPT 90732 refers to the administration of the pneumococcal polysaccharide vaccine, 23-valent (PPSV23), for adults or immunosuppressed patients aged 2 years or older. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 90732 procedures.

1. What is CPT 90732?

CPT 90732 is a medical billing code used to describe the administration of the pneumococcal polysaccharide vaccine, 23-valent (PPSV23), for adults or immunosuppressed patients aged 2 years or older. This vaccine is administered to protect against meningitis and pneumonia caused by Streptococcus pneumoniae.

2. 90732 CPT code description

The official description of CPT code 90732 is: “Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use.”

3. Procedure

  1. The provider discusses the risks, benefits, and potential side effects of the 23-valent pneumococcal polysaccharide vaccine with the patient, parent, or guardian.
  2. The patient is appropriately prepped for the vaccine administration.
  3. The provider administers the vaccine either intramuscularly or subcutaneously, depending on the patient’s age and medical condition.
  4. After the vaccine is administered, the provider monitors the patient for any immediate adverse reactions or side effects.
  5. The provider documents the vaccine administration, including the product used, administration route, and purpose, in the patient’s medical record.

4. Qualifying circumstances

Individuals eligible to receive CPT code 90732 services include adults and immunosuppressed patients aged 2 years or older who are at risk for meningitis and pneumonia caused by Streptococcus pneumoniae. This may include individuals with chronic medical conditions, such as heart disease, lung disease, or diabetes, as well as those with weakened immune systems due to HIV/AIDS, cancer, or other medical conditions.

5. When to use CPT code 90732

It is appropriate to bill the 90732 CPT code when the provider administers the 23-valent pneumococcal polysaccharide vaccine to eligible patients aged 2 years or older. This code should be used in conjunction with separate codes for vaccine administration, the actual vaccine, and an office visit, based on the documentation provided by the provider.

6. Documentation requirements

To support a claim for CPT 90732, the provider must document the following information in the patient’s medical record:

  • The patient’s age and medical condition, indicating their eligibility for the vaccine.
  • The risks, benefits, and potential side effects of the vaccine discussed with the patient, parent, or guardian.
  • The vaccine product administered, including the manufacturer and lot number.
  • The administration route (intramuscular or subcutaneous) and the specific site of injection.
  • The date and time of the vaccine administration.
  • Any immediate adverse reactions or side effects observed after the vaccine administration.

7. Billing guidelines

When billing for CPT code 90732, follow these guidelines:

  • Report separate codes for vaccine administration, the actual vaccine, and an office visit, based on the documentation provided by the provider.
  • Include sufficient documentation from the provider explaining the product administered, administration route, and purpose.
  • Some insurance companies may require modifier 25 to be appended to the associated evaluation and management (E/M) code.
  • Medicare and private insurance companies may have different guidelines for reporting vaccines or for reporting certain vaccines during the same visit, such as flu and pneumonia vaccines. Check with individual payers for their specific guidelines and have the policy in writing to protect your practice in the event of payer questions.

8. Historical information

CPT 90732 was added to the Current Procedural Terminology system on January 1, 1990. Since then, there have been several updates to the code description, with the most recent change occurring on January 1, 2016.

9. Similar codes to CPT 90732

Five similar codes to CPT 90732 include:

  • CPT 90670: This code is used for the 13-valent pneumococcal conjugate vaccine (PCV) administration.
  • CPT 90672: This code is used for the administration of the quadrivalent live attenuated influenza vaccine.
  • CPT 90715: This code is used for the administration of the tetanus, diphtheria, and acellular pertussis (Tdap) vaccine.
  • CPT 90716: This code is used for the administration of the varicella (chickenpox) vaccine.
  • CPT 90723: This code is used for the administration of the diphtheria, tetanus, pertussis, hepatitis B, and poliovirus vaccine.

10. Examples

Here are 10 detailed examples of CPT code 90732 procedures:

  1. A 65-year-old patient with a history of chronic obstructive pulmonary disease (COPD) receives the PPSV23 vaccine to protect against pneumonia.
  2. A 50-year-old patient with diabetes receives the PPSV23 vaccine as part of their routine preventive care.
  3. A 30-year-old patient with HIV/AIDS receives the PPSV23 vaccine to protect against pneumococcal infections.
  4. A 40-year-old patient with a history of heart disease receives the PPSV23 vaccine as a preventive measure.
  5. A 2-year-old child with a weakened immune system due to cancer treatment receives the PPSV23 vaccine.
  6. A 60-year-old patient with a history of smoking and lung disease receives the PPSV23 vaccine to protect against pneumonia.
  7. A 45-year-old patient with a history of alcoholism and liver disease receives the PPSV23 vaccine as part of their preventive care.
  8. A 55-year-old patient with a history of kidney disease receives the PPSV23 vaccine to protect against pneumococcal infections.
  9. A 35-year-old patient with a history of asthma receives the PPSV23 vaccine as a preventive measure.
  10. A 70-year-old patient with a history of rheumatoid arthritis and immunosuppressive therapy receives the PPSV23 vaccine to protect against pneumonia.

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