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Wiki Pertussis Catch-up code

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lisamilo

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Hi, We have a 7 yr old that has never had DtaP and needs to get their pertussis. There is not a single immunization for this, and the only thing I can find is 90715 TdaP which CPT states is valid for 7 and older, but recommended ages from manufacturer are 10-64. I checked the CDC and that was the only immunization that they recommended for this situation. What are other practices doing? Thanks!
Lisa M, Sacramento CA.
 
I ran across this article some time back. Maybe you will find it helpful.


Q: I am trying to find the vaccine code for DTaP for patients who are over the age of 7 years old. I know that for patients under 7 years old, to use CPT code 90700. I have asked several coders about this, and some of them have suggested using CPT 90715. I did some research and found that DTaP is not the same vaccine as Tdap. Please help with some clarification.


A: You are correct that the code for DTaP is different from the code for Tdap. Because there is no specific listing for the code that you need, unfortunately, I think you are forced to use the unlisted vaccine/toxoid code for this vaccination and submit a report to the payer.

I would like to provide this additional advice or information with regards to the question of a CPT code for DTaP vaccine administered to an individual over 7 yrs old. I would definitely not report the specific code for the Tdap (90715) if the DTaP vaccine truly was given. The FDA has approved/licensed Tdap for protection against the three diseases that DTaP provides; however, this vaccine is for adolescents and adults. Tdap is different from DTaP in this way: Tdap is specially formulated with lesser quantities of some of the toxoids. DTaP is not approved for use in individuals over age 7 as there are significant risks for individuals of that age receiving the stated vaccine. Providers should take care in documenting these two different vaccines and ensure that the exact vaccine they administer is what they document.

Here is further advice concerning a situation where the provider has documented a vaccination performed outside the age specified in the CPT code description. First of all, confirm the exact vaccine that the provider administered. Second, if this first attempt at clarification reveals that the provider administered a vaccine to a patient outside the recommended age range, then I would suggest recommending that the provider follow the practices that the FDA/CDC have established for the use of these vaccines. For the CPT coding aspect of this, I personally would not recommend using the specific code that specifies an age range if that particular vaccine was given to an individual outside that age range. Without any further specific and official advice, I would recommend using the unlisted vaccine code.


http://health-information.advanceweb.com/Editorial/Content/PrintFriendly.aspx?CC=76729
 
In this case you would have to give the Tdap (90715). If the Dtap (90700) is given then it will be denied as procedure inconsistent with age. I've seen it happen at one of our practices and they basically had to write the charge off because it was their error.
 
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