Pediatric Coding Alert

The 1999 CPT codes, which will become effective in January, include new codes in two important areas for pediatricians: immunizations and neonatal intensive care. As we noted in the September issue, these new codes are expected to help pediatric practices get better reimbursement, although the sheer mass of new, highly specific vaccine codes may be overwhelming at first.

New Vaccine Codes Cover Administration, Different Dosages

First of all, pediatricians now have the long-awaited codes for administration of vaccines: CPT 90471 for administration of a single or combination vaccine; 90472 for administration of two single or combination vaccines. These include percutaneous, intradermal, subcutaneous, intramuscular and jet injections and/or intranasal or oral administration. If immunizations are given as part of preventive care services (99381-99385, 99391-99395), you should use those codes as well. You must also report the vaccine code.

Note: The question remains: Will insurance companies pay for these new codes? Look for the results of a reader survey on this topic early next year in PCA.

The vaccine codes have now been divided into different dosage schedules. The reason for this is that the exact product needs to be reported in order to track vaccine distribution and the occurrence of adverse events. CPT makes it clear that you must use a combination codeand not individual componentsif you are using a combination vaccine. If a specific code is not available, you should use the unlisted procedure code (90749). Here are the new codes.

90633Hepatitis A vaccine, pediatric/adolescent dosage - 2 dose schedule, for intramuscular use

90634Hepatitis A vaccine, pediatric/adolescent dosage - 3 dose schedule, for intramuscular use

90645Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use

90646Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use

90647Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use

90648Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use

90657Influenza virus vaccine, split virus, 6-35 months dosage, for intramuscular or jet injection use

90658Influenza virus vaccine, split virus, 3 years and above dosage, for intramuscular or jet injection use

90659Influenza virus vaccine, whole virus, for intramuscular or jet injection use

90660Influenza virus vaccine, live, for intranasal use

90675Rabies vaccine, for intramuscular use

90676Rabies vaccine, for intradermal use

90680Rotavirus vaccine, tetravalent, live, for oral use

Editors Note: We will cover these new immunization codes more in future issues of PCA.

In addition, the CPT verbiage for some other vaccines has been revised. Here are the revised immunization codes.

90700Diphtheria, tetanus toxoid, and acellular pertussis vaccine (DTaP), for intramuscular use

90701Diphtheria, tetanus toxoid, and whole cell pertussis vaccine (DTP), for intramuscular use

90702Diphtheria and tetanus toxoid (DT) adsorbed for pediatric use, for intramuscular use

90703Tetanus toxoid adsorbed, for intramuscular or jet injection use

90704Mumps virus vaccine, live, for subcutaneous or jet injection use

90705Measles virus vaccine, live, for subcutaneous or jet injection use

90706Rubella virus vaccine, live, for subcutaneous or jet injection use

90707Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous or jet injection use

90708Measles and rubella virus vaccine, live, for subcutaneous or jet injection use

90709Rubella and mumps virus vaccine, live, for subcutaneous use

90710Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous use

90712Poliovirus vaccine, (any type(s)) (OPV), live, for oral use

90713Poliovirus vaccine, inactivated, (IPV), for subcutaneous use

90716Varicella virus vaccine, live, for subcutaneous use

90720Diphtheria, tetanus toxoid, and whole cell pertussis
vaccine and Hemophilus influenza B vaccine (DTP-Hib), for intramuscular use

90721Diphtheria, tetanus toxoid, and acellular pertussis vaccine and Hemophilus influenza b vaccine (DTaP-Hib), for intramuscular use

90744Hepatitis B vaccine, pediatric or pediatric/adolescent dosage, for intramuscular use

90745Hepatitis B vaccine, adolescent/high risk infant dosage, for intramuscular use

90748Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular use

90749Unlisted vaccine/toxoid

Note: Due to the update in immunization codes, the following codes have been deleted: 90711, 90714, 90750-90754, 90755, 90757, 90760-90764, 90774, 90778.

New Neonatal Intensive Care Code

A very obvious gap in the neonatal intensive care codes has been filled by the new code 99298. This code is for babies who need intensive monitoring, but are not critically ill. The other two subsequent neonatal intensive care codes are for critically ill babies (99296 is for critically ill and unstable, 99297 is for critical ill and stable). Here is the descriptor of 99298: Subsequent neonatal intensive care, per day, for the evaluation and management of the recovering very low birth weight infant (less than 1500 grams). Very low birth weight neonates who are no longer critically ill continue to require intensive cardiac and respiratory monitoring, continuous and/or frequent vital sign monitoring, heat maintenance, enteral and/or parenteral nutritional adjustments, laboratory and oxygen monitoring and constant observation by the health care team under direct physician supervision. Neonates of this level of care would be expected to require infrequent changes in respiratory, cardiovascular and/or fluid and electrolyte therapy as those induced under 99296 or 99297. This code encompasses intensive care provided on days subsequent to the admission date. (99295 is the code for care on the date of admission.)

The same procedures are included in the global descriptor for 99298 as for 99296 and 99297: umbilical, central or peripheral vessel catheterization, oral or nasogastric tube placement, endotracheal intubation, lumbar puncture, suprapubic bladder aspiration, bladder catheterization, initiation and management of mechanical ventilation or continuous positive airway pressure (CPAP), surfactant administration, intravascular fluid administration, transfusion of blood components, vascular punctures, invasive or noninvasive electronic monitoring of vital signs, bedside pulmonary function testing, and/or monitoring or interpretation of blood gases or oxygen saturation. Other procedures should be reported with their own codes.