Wiki Code for DTaP in 15 year old

[rhuling@obfmc.com]

Have 15 year old that has never had any vaccinations. Came in was given several including DTaP but claim is getting hung up. what code and modifier (if any ) can be used to show this is individual that has had no vaccinations.

 

[HangarPilot]

A 15-year-old who was never vaccinated should not have received DTaP (DTaP is for children under 7 years old). Per the CDC catch-up schedule, they should have received Tdap followed by Td at the proper intervals to complete the series.

https://www.cdc.gov/vaccines/schedules/hcp/imz/catchup.html

Now, the schedule does have instructions on what to do in cases of "DTaP inadvertently given after the 7th birthday" so MEDICALLY, the vaccine is probably ok (I'd clarify that with a provider though) but I would suspect that the CPT is being denied automatically because the patient is older than 7.

Again, since there are instructions for what to do if when it's "inadvertently given after the 7th birthday" ... maybe you could appeal it getting the provider to prove how/why this was ok ... but DTaP costs about $20 so I'm not sure it would be worth the time/money to fight it. Personally, I would write it off because I think it would be a long hard battle. I mean, the DTaP product insert states it's indicated for "infants and children 6 weeks through 6 years of age (prior to 7th birthday)" so that's probably what the insurance will stand behind.