Pediatric Coding Alert

Question: Can you explain when I should use 90619 or 90734 for a meningococcal A, C, Y, W conjugate?

AAPC Forum Participant

Answer: Even though 90619 (Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier (MenACWY-TT), for intramuscular use) and 90734 (Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, diphtheria toxoid carrier (MenACWY-D) or CRM197 carrier (MenACWY-CRM), for intramuscular use) are both conjugate vaccines designed to protect against meningococcal disease caused by serogroups A, C, Y, and W, the two differ in their carriers.

Conjugate vaccines work by combining a weak antigen (in the case of these vaccines, the meningococcal antigen) with a strong antigen that creates a greater response in the patient’s immune system, thereby boosting the immune response to the weaker antigen. In the case of 90619, the strong antigen carrier is a tetanus toxoid; for 90734, it is a diphtheria toxoid.

So, you will use 90619 for the MenACWY-TT vaccine MenQuadfi, while you will code the MenACWY-D vaccine Menactra and the MenACWY-CRM vaccine Menveo with 90734.

Important reminder 1: The MenACWY vaccines do not protect against meningococcal serogroup B and vice versa. So, your provider will also administer vaccines for meningococcal serogroup B, such as Trumenba and Bexsero, which you will code using 90620 (Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B (MenB-4C), 2 dose schedule, for intramuscular use).

Important reminder 2: No matter which vaccine your pediatrician administers, you will need to document vaccine administration code 90460 (Immunization administration through 18 years of age via any route of administration, with counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered) in addition to the code for the vaccine itself.